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Sample records for guanare estado portuguesa

  1. [Vertebrate mortality in the Guanare-Guanarito road, Portuguesa state, Venezuela].

    PubMed

    Seijas, Andrés Eloy; Araujo-Quintero, Alexis; Velásquez, Nadines

    2013-12-01

    Roads directly or indirectly affect the structure, dynamics and function of ecosystems that they traverse. Most studies on the effect of roads on wildlife focus on the evaluation of mortality of vertebrates by vehicle collisions. Despite the extensive road network that exists in Venezuela, studies of wildlife mortality in them are scarce. In this paper, we analyzed the temporal and spatial pattern of vertebrate's collisions along the road Guanare-Guanarito, in Portuguesa state. We travelled 26 times between these towns (74 km) to localize dead vertebrates, at a speed of 50-60km/h. of those trips were conducted from March 13 to October 26, 2010, and 10 additional trips from December 7, 2009 to December 14, 2010; these ones, with the aim to include months and seasons that were insufficiently sampled during the first period. The elapsed time between trips varied from 14 to 37 days. The total distance traveled was 1 924 km. Dead animals found amounted 464 individuals, 66 of them were birds (25 identified species), 130 mammals (15 species) and 268 reptiles (18 species). The species with the highest number of individuals were the snake Leptodeira annulata (n=119), the oppossum Didelphis marsupialis (n=39) and the spectacled caiman Caiman crocodilus (n=33). Excluding domestic animals, the rate of road-killed vertebrates was 0.2282 indiv./km, a figure 28.3% higher than previous studies in the same road. Changes in the relative number of collisions for some species, respect to the numbers reported 20 years ago, were linked to the increase in traffic flow and changes in land use. Road segments with collision rates higher than expected by chance were identified. Collition by cars may be the principal cause of mortality for species like the tamandua (Tamandua tetradactyla) and the giant anteater (Myrmecophaga tridactyla), the last considered a vulnerable species. Some basic measures are proposed to reduce wildlife mortality on the road.

  2. Epidemiology of coronary artery bypass grafting at the Hospital Beneficência Portuguesa, São Paulo

    PubMed Central

    de Sousa, Alexandre Gonçalves; Fichino, Maria Zenaide Soares; da Silva, Gilmara Silveira; Bastos, Flávia Cortez Colosimo; Piotto, Raquel Ferrari

    2015-01-01

    Introduction The knowledge of the prevalence of risk factors and comorbidities, as well as the evolution and complications in patients undergoing coronary artery bypass graft allows comparison between institutions and evidence of changes in the profile of patients and postoperative evolution over time. Objective To profile (risk factors and comorbidities) and clinical outcome (complications) in patients undergoing coronary artery bypass graft in a national institution of great surgical volume. Methods A retrospective cohort study of patients undergoing coronary artery bypass graft in the hospital Beneficência Portuguesa de São Paulo, from July 2009 to July 2010. Results We included 3,010 patients, mean age of 62.2 years and 69.9% male. 83.8% of patients were hypertensive, 36.6% diabetic, 44.5% had dyslipidemia, 15.3% were smokers, 65.7% were overweight/obese, 29.3% had a family history of coronary heart disease. The expected mortality calculated by logistic EuroSCORE was 2.7%. The isolated CABG occurred in 89.3% and 11.9% surgery was performed without cardiopulmonary bypass. The most common complication was cardiac arrhythmia (18.7%), especially acute atrial fibrillation (14.3%). Pneumonia occurred in 6.2% of patients, acute renal failure in 4.4%, mediastinites in 2.1%, stroke in 1.8% and AMI in 1.2%. The in-hospital mortality was 5.4% and in isolated coronary artery bypass graft was 3.5%. The average hospital stay was 11 days with a median of eight days (3-244 days). Conclusion The profile of patients undergoing coronary artery bypass graft surgery in this study is similar to other published studies. PMID:25859865

  3. Síntesis del estado del conocimiento del ciclo de carbono en ecosistemas boscosos de los Estados Unidos

    Treesearch

    Michael G. Ryan; Mark E. Harmon; Richard A. Birdsey; Christian P. Giardina; Linda S. Heath; Richard A. Houghton; Robert B. Jackson; Duncan C. McKinley; James F. Morrison; Brian C. Murray; Diane E. Pataki; Kenneth E. Skog

    2010-01-01

    Los bosques juegan un papel central en el ciclo de carbono de los Estados Unidos y global. El secuestro de carbono de los bosques de los Estados Unidos, a través de su crecimiento y la cosecha de productos madereros, compensa en la actualidad entre un 12 y un 19% de las emisiones de carbono asociadas al uso de combustible fósil de dicho país. El ciclo natural de un...

  4. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED).

    PubMed

    Dinis-Ribeiro, M; Areia, M; de Vries, A C; Marcos-Pinto, R; Monteiro-Soares, M; O'Connor, A; Pereira, C; Pimentel-Nunes, P; Correia, R; Ensari, A; Dumonceau, J M; Machado, J C; Macedo, G; Malfertheiner, P; Matysiak-Budnik, T; Megraud, F; Miki, K; O'Morain, C; Peek, R M; Ponchon, T; Ristimaki, A; Rembacken, B; Carneiro, F; Kuipers, E J

    2012-01-01

    Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter Study Group (EHSG), the European Society of Pathology (ESP) and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach (termed MAPS). A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia, and the need for adequate staging in the case of high grade dysplasia, and they focus on treatment and surveillance indications and methods.

  5. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED).

    PubMed

    Dinis-Ribeiro, M; Areia, M; de Vries, A C; Marcos-Pinto, R; Monteiro-Soares, M; O'Connor, A; Pereira, C; Pimentel-Nunes, P; Correia, R; Ensari, A; Dumonceau, J M; Machado, J C; Macedo, G; Malfertheiner, P; Matysiak-Budnik, T; Megraud, F; Miki, K; O'Morain, C; Peek, R M; Ponchon, T; Ristimaki, A; Rembacken, B; Carneiro, F; Kuipers, E J

    2012-01-01

    Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy, the European Helicobacter Study Group, the European Society of Pathology, and the Sociedade Portuguesa de Endoscopia Digestiva have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach. A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia and the need for adequate staging in the case of high-grade dysplasia, and they focus on treatment and surveillance indications and methods.

  6. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)

    PubMed Central

    Dinis-Ribeiro, M.; Areia, M.; de Vries, A. C.; Marcos-Pinto, R.; Monteiro-Soares, M.; O'Connor, A.; Pereira, C.; Pimentel-Nunes, P.; Correia, R.; Ensari, A.; Dumonceau, J. M.; Machado, J. C.; Macedo, G.; Malfertheiner, P.; Matysiak-Budnik, T.; Megraud, F.; Miki, K.; O'Morain, C.; Peek, R. M.; Ponchon, T.; Ristimaki, A.; Rembacken, B.; Carneiro, F.; Kuipers, E. J.

    2012-01-01

    Atrophic gastritis, intestinal metaplasia, and epithelial dysplasia of the stomach are common and are associated with an increased risk for gastric cancer. In the absence of guidelines, there is wide disparity in the management of patients with these premalignant conditions. The European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter Study Group (EHSG), the European Society of Pathology (ESP) and the Sociedade Portuguesa de Endoscopia Digestiva (SPED) have therefore combined efforts to develop evidence-based guidelines on the management of patients with precancerous conditions and lesions of the stomach (termed MAPS). A multidisciplinary group of 63 experts from 24 countries developed these recommendations by means of repeat online voting and a meeting in June 2011 in Porto, Portugal. The recommendations emphasize the increased cancer risk in patients with gastric atrophy and metaplasia, and the need for adequate staging in the case of high grade dysplasia, and they focus on treatment and surveillance indications and methods. PMID:22198778

  7. Faculty Activity Analysis in the Universidad Tecnica Del Estado Campuses.

    ERIC Educational Resources Information Center

    Karadima, Oscar

    An analysis of academic activities of college faculty at the eight campuses of Chile's Universidad Tecnica del Estado was conducted. Activities were grouped into seven categories: direct teaching, indirect teaching, research, community services, faculty development, academic administration, and other activities. Following the narrative…

  8. Faculty Activity Analysis in the Universidad Tecnica Del Estado Campuses.

    ERIC Educational Resources Information Center

    Karadima, Oscar

    An analysis of academic activities of college faculty at the eight campuses of Chile's Universidad Tecnica del Estado was conducted. Activities were grouped into seven categories: direct teaching, indirect teaching, research, community services, faculty development, academic administration, and other activities. Following the narrative…

  9. Paleoenvironmental and paleoclimatic investigations on Isla de los Estados, Argentina

    NASA Astrophysics Data System (ADS)

    Björck, S.; Fernandez, M.; Hjort, C.; Ljung, K.; Martinez, O.; Möller, P.; Ponce, F.; Rabassa, J.; Roig, F.; Unkel, I.; Wohlfarth, B.

    2007-05-01

    The expedition in November-December 2005 to Isla de los Estados (Staten Island) off the southeastern tip of South America was a cooperative venture between Lund University (LU) and Stockholm University (SU) in Sweden and the CADIC-CONICET Institute in Ushuaia, Argentina. The aim of the expedition was threefold: (1) to extend the Swedish paleoclimatic "ATLANTIS"-project (Greenland, Iceland, Faroe Islands, Azores, Grenada, Tristan da Cunha; PI S Björck) to the southern part of the South American continent, (2) to connect earlier glacial and climate history reconstructions from the Antarctic Peninsula to equivalents north of the Drake Passage in southernmost South America, and (3) to complement paleo-information available from the Tierra del Fuego mainland with information from Isla de los Estados. Focus was on two areas in the northern and north-western part of the island, Bahía Colnett and Bahia Crossley. Detailed geomorphologic and stratigraphic mapping of glacial deposits were combined with sampling sediments for OSL dating. To reconstruct the paleoclimatic development of Isla de los Estados since the last ice retreat, four main peat bog/lake sites were cored and sampled. In addition, living trees of Nothofagus and old logs preserved in the peat were sampled for dendrochronological and dendroclimatological studies. Preliminary results show that the deglaciation of the study area occurred before 16500 cal yr BP. Detailed multi- proxy analyses of the four sequences are under way and first results will be presented.

  10. Argentine gas system underway for Gas del Estado

    SciTech Connect

    Bosch, H.

    1980-10-01

    Gas del Estado's giant 1074-mile Centro-Oeste pipeline project - designed to ultimately transport over 350 million CF/day of natural gas from the Neuquen basin to the Campo Duran-Buenos Aires pipeline system - is now underway. The COGASCO consortium of Dutch and Argentine companies awarded the construction project will also operate and maintain the system for 15 years after its completion. In addition to the 30-in. pipelines, the agreement calls for a major compressor station at the gas field, three intermediate compressor stations, a gas-treatment plant, liquids-recovery facilities, and the metering, control, communications, and maintenance equipment for the system. Fabricated in Holland, the internally and externally coated pipe will be double-jointed to 80-ft lengths after shipment to Argentina; welders will use conventional manual-arc techniques to weld the pipeline in the field.

  11. Radioactive source materials in Los Estados Unidos de Venezuela

    USGS Publications Warehouse

    Wyant, Donald G.; Sharp, William N.; Rodriguez, Carlos Ponte

    1953-01-01

    This report summarizes the data available on radioactive source materials in Los Estados Unidos de Venezuela accumulated by geologists of the Direccions Tecnica de Geolgia and antecedent agencies prior to June 1951, and the writers from June to November 1951. The investigation comprised preliminary study, field examination, office studies, and the preparation of this report, in which the areas and localities examined are described in detail, the uranium potentialities of Venezuela are summarized, and recommendations are made. Preliminary study was made to select areas and rock types that were known or reported to be radioactive or that geologic experience suggests would be favorable host for uranium deposits, In the office, a study of gamma-ray well logs was started as one means of amassing general radiometric data and of rapidly scanning many of ye rocks in northern Venezuela; gamma-ray logs from about 140 representative wells were examined and their peaks of gamma intensity evaluated; in addition samples were analyzed radiometrically, and petrographically. Radiometic reconnaissance was made in the field during about 3 months of 1951, or about 12 areas, including over 100 localities in the State of Miranda, Carabobo, Yaracuy, Falcon, Lara, Trujillo, Zulia, Merida, Tachira, Bolivar, and Territory Delta Amacuro. During the course of the investigation, both in the filed and office, information was given about geology of uranium deposits, and in techniques used in prospecting and analysis. All studies and this report are designed to supplement and to strengthen the Direccion Tecnica de Geologias's program of investigation of radioactive source in Venezuela now in progress. The uranium potentialities of Los Estados de Venezuela are excellent for large, low-grade deposits of uraniferous phospahtic shales containing from 0.002 to 0.027 percent uranium; fair, for small or moderate-sized, low-grade placer deposits of thorium, rare-earth, and uranium minerals; poor, for

  12. Reading: Students' Attitudes and Interests in Fourth, Fifth, and Sixth Grades in Official Portuguese Schools in the USA (A Leitura: Atitudes e Preferencias dos Educandos do 4th, 5th, e 6th Anos de Escolaridade nas Escolas Oficiais Portuguesas nos Estados Unidos da America).

    ERIC Educational Resources Information Center

    Castanho, Maria da Graca Borges

    A study investigated attitudes and preferences concerning reading among fourth-, fifth-, and sixth-grade students in Portuguese-language schools in the United States. Extrinsic factors influencing students (parents, teachers) were also analyzed. The research took place in 10 schools in 5 states. Data were obtained using questionnaires (students)…

  13. H3+: superficies de energía potencial, estados y transiciones rovibracionales

    NASA Astrophysics Data System (ADS)

    Aguado, M. Paniagua Y. A.

    Hemos calculado varias superficies globales de energía potencial para el estado fundamental y excitados del sistema H3+ en más de ocho mil geometrías diferentes usando una base (9s 3p 1d)/[4s 3p 1d] en cada átomo de Hidrógeno y mediante un método de cálculo de interacción de configuraciones completa (FCI). Hemos ajustado las superficies a formas analíticas del tipo Aguado y Paniagua con un error promedio menor de 50 cm-1 y menor en el pozo de potencial del estado fundamental. Finalmente hemos calculado y analizado los niveles vibracionales para los dos estados electrónicos más bajos, siendo la desviación respecto de los mejores valores publicados, tanto experimentales como teóricos, de unos pocos números de onda.

  14. Actividad funcional cerebral en estado de reposo: REDES EN CONEXIÓN

    PubMed Central

    Proal, Erika; Alvarez-Segura, Mar; de la Iglesia-Vayá, Maria; Martí-Bonmatí, Luis; Castellanos, F. Xavier

    2015-01-01

    Resumen El análisis de la conectividad funcional mediante resonancia magnética funcional (RMf) puede llevarse a cabo durante la realización de una tarea, la percepción de un estímulo o en estado de reposo. Estos análisis han demostrado su fiabilidad y reproducibilidad con diferentes enfoques (matemáticos, estadísticos, físicos) para seleccionar los vóxeles activados. El estudio de la señal de baja frecuencia en la actividad cerebral a través del contraste BOLD en estado de reposo ha revelado patrones de actividad cortical sincronizados, permitiendo describir la arquitectura funcional intrínseca del cerebro humano. La comunidad científica internacional dispone de recursos compartidos que contribuirán mediante este análisis de RMf en estado de reposo a la obtención de diagnósticos y tratamientos más precisos y avanzados en el campo de las neurociencias. PMID:21365601

  15. La guerra de los Estados Unidos contra la inmigración. Efectos paradójicos1

    PubMed Central

    Massey, Douglas S.; Pren, Karen A.

    2016-01-01

    Resumen A finales de la década de los cincuenta, Estados Unidos permitía la entrada de aproximadamente medio millón de inmigrantes mexicanos al año, de los cuales 450.000 entraban con visados de trabajo temporal y 50.000 llegaban con visados de residentes permanentes. A mediados de los años sesenta, los cambios en la política migratoria de Estados Unidos realizados en nombre de los derechos civiles redujeron drásticamente las oportunidades de entrada legal a Estados Unidos. Se eliminaron los visados de trabajo temporal y se limitaron los visados de residentes a 20.000 por año. Con las oportunidades de entrada legal restringidas, los flujos migratorios ya establecidos simplemente continuaron, fuera de los límites legales, dando comienzo a una inesperada reacción en cadena de eventos que culminaron en una guerra total contra los inmigrantes y el rápido crecimiento -sin precedentes- de población residente no autorizada en Estados Unidos. El presente artículo demuestra que el aumento de inmigración indocumentada en los Estados Unidos y el crecimiento de la población sin papeles son un producto de políticas migratorias y fronterizas mal concebidas. PMID:27076695

  16. Strategic Planning for Institutions of Higher Education: A Content Analysis for the Universidad Tecnica del Estado Planning System.

    ERIC Educational Resources Information Center

    Karadima, Oscar

    Ten-year development plans of each of the eight campuses of the Universidad de Santiago de Chile, formerly called Universidad Tecnica del Estado, are evaluated, using content analysis. In addition to narrative descriptions, diagrams illustrate the features of each plan, which covers the period 1983-1993. Topics covered by the plans were grouped…

  17. Strategic Planning for Institutions of Higher Education: A Content Analysis for the Universidad Tecnica del Estado Planning System.

    ERIC Educational Resources Information Center

    Karadima, Oscar

    Ten-year development plans of each of the eight campuses of the Universidad de Santiago de Chile, formerly called Universidad Tecnica del Estado, are evaluated, using content analysis. In addition to narrative descriptions, diagrams illustrate the features of each plan, which covers the period 1983-1993. Topics covered by the plans were grouped…

  18. Developing Flexible Dual Master's Degree Programs at UPAEP (Universidad Popular Autonoma del Estado de Puebla) and OSU (Oklahoma State University)

    ERIC Educational Resources Information Center

    Fabregas-Janeiro, Maria G.; de la Parra, Pablo Nuno

    2012-01-01

    In 2006, UPAEP (Universidad Popular Autonoma del Estado de Puebla) and OSU (Oklahoma State University) signed a MOU (memorandum of understanding) to develop more than 20 dual master's degree programs. This special partnership has allowed students from Mexico and the United States to study two master degree programs, in two languages, in two…

  19. FLOATING COMMUNITIES OF ALGAE IN AN ARTIFICIAL POND IN THE PARQUE DO ESTADO, SÃO PAULO, BRAZIL(1).

    PubMed

    de Mattos Bicudo, C E; Teixeira Bicudo, R M

    1967-12-01

    A fresluvater floating algal community was repeatedly observed in an artificial pond in the Parque do Estado São Paulo, Brazil. The ontogeny and composition of the community are discussed and are related to oxygen liberation during photosynthesis of the periphyton, or of the pond-bottom algne, which carries up portions of the algae growing there.

  20. [Men of the sugarcane fields and their hospitals: the architecture of health under the Estado Novo].

    PubMed

    Monteiro, Marcia Rocha

    2011-12-01

    The article explores the emergence of an architectural heritage in the realm of healthcare assistance for workers in the sugarcane agroindustry in Brazil following enactment of the law known as the Estatuto da Lavoura Canavieira (1941), under the auspices of the Instituto do Açúcar e do Álcool and as part of Estado Novo policies (1937-1945). The institute proposed solutions based on surveys conducted at sugarcane mills in cane-producing states and on the medical and hospital system adopted by the institute's enlightened bureaucracy in the 1940s, which took the U.S. system as its model. Special focus is given to the central hospitals in Pernambuco and especially in Alagoas, which opposed institute guidelines.

  1. Susceptibility mapping in the Río El Estado watershed, Pico de Orizaba volcano, Mexico

    NASA Astrophysics Data System (ADS)

    Legorreta Paulin, G.; Bursik, M. I.; Lugo Hubp, J.; Paredes Mejía, L.; Aceves Quesada, F.

    2013-12-01

    In volcanic terrains, dormant stratovolcanoes are very common and can trigger landslides and debris flows continually along stream systems, thereby affecting human settlements and economic activities. It is important to assess their potential impact and damage through the use of landslide inventory maps and landslide models. This poster provides an overview of the on-going research project (Grant SEP-CONACYT no 167495) from the Institute of Geography at the National Autonomous University of Mexico (UNAM) that seeks to conduct a multi-temporal landslide inventory and produce a landslide susceptibility map by using Geographic Information Systems (GIS). The Río El Estado watershed on the southwestern flank of Pico de Orizaba volcano, the highest mountain in Mexico, is selected as a study area. The catchment covers 5.2 km2 with elevations ranging from 2676.79 to 4248.2 m a.s.l. and hillslopes between 5° and 56°. The stream system of Río El Estado catchment erodes Tertiary and Quaternary lavas, pyroclastic flows, and fall deposits. The geologic and geomorphologic factors in combination with high seasonal precipitation, high degree of weathering, and steep slopes predispose the study area to landslides. The method encompasses two main levels of analysis to assess landslide susceptibility. The first level builds a historic landslide inventory. In the study area, an inventory of more than 100 landslides was mapped from interpretation of multi-temporal aerial orthophotographs and local field surveys to assess and describe landslide distribution. All landslides were digitized into a GIS, and the spatial geo-database of landslides was constructed from standardized GIS datasets. The second level calculates the susceptibility for the watershed. Multiple Logistic Regression (MLR) was used to examine the relationship between landsliding and several independent variables (elevation, slope, terrain curvature, flow direction, saturation, contributing area, land use, and geology

  2. Late Quaternary glaciation history of Isla de los Estados, southeasternmost South America

    NASA Astrophysics Data System (ADS)

    Möller, Per; Hjort, Christian; Björck, Svante; Rabassa, Jorge; Ponce, Juan Federico

    2010-05-01

    Isla de los Estados is a mountainous island southeast of Tierra del Fuego, in southernmost South America. Its central and eastern parts have an alpine topography, transected by U-shaped valleys, small, partly over-deepened fjords, and a multitude of abandoned cirques, all associated with extensive former local glaciations. Traces of glacial erosion generally reach 400-450 m a.s.l., and above that trimline a distinct sharp-edged nunatak derived landscape is present. The westernmost part of the island has a lower, more subdued topography, reflecting its "softer" geology but possibly also over-running and erosion by mainland-derived ice streams. The present study concentrated on glacigenic sediment sequences exposed along coastal erosional cliffs. A combination of OSL and 14C datings show that these sediments mostly date from the latest (Wisconsinan/Weichselian) glacial cycle, i.e. from the last ca. 100 ka with the oldest (glaciolacustrine) deposits possibly as old as 90-80 ka. The upper parts of overlying tills, with associated lateral and terminal moraines from glaciers that expanded onto an eustatically exposed dry shelf north of the island, date from the last global glacial maximum (LGM). Radiocarbon ages of peat and lake sediments indicate that deglaciation began 17-16 cal ka BP.

  3. "O Mundo da Lingua Portuguesa," a Supplementary Cultural Lesson.

    ERIC Educational Resources Information Center

    Kennedy, James H.

    The text of a classroom lesson on the distribution and use of the Portuguese language in African countries, written in Portuguese and containing an explanation of and practice in using the definite article with African place names, is presented. The lesson is accompanied by vocabulary notes in the margin, a list of questions on the text, and a mpa…

  4. Servicio de Mapas en Internet para la Salud Ambiental en la Region Fronteriza Entre los Estados Unidos y Mexico

    USGS Publications Warehouse

    Buckler, Denny; Stefanov, Jim

    2004-01-01

    La region fronteriza de los Estados Unidos y Mexico abarca una gran diversidad de ambientes fisicos y habitaciones, entre los cuales estan los humedales, desiertos, pastos, montanas, y bosques. Estos a su vez son unicos en cuanto a su diversidad de recursos acuaticos minerales, y biologicos. La region se interconecta economica, politica, y socialmente debido a su herencia binacional. En 1995, cerca de 11 millones de habitantes vivian en la zona adyacente a la frontera. Un estudio sugiere que esa poblacion podria doblarse antes del ano 2020.

  5. [Proposal for early detection of ethanol consumption in students of the Universidad Autónoma del Estado de Morelos].

    PubMed

    García-Jiménez, Sara; Erazo-Mijares, Miguel; Toledano-Jaimes, Cairo D; Monroy-Noyola, Antonio; Bilbao-Marcos, Fernando; Sánchez-Alemán, Miguel A; Déciga-Campos, Myrna

    2016-01-01

    The present study determined through analytic techniques the quantification of some biomarkers that have been useful to detect early ethanol consumption in a college population. A group of 117 students of recent entry to the Universidad Autónoma del Estado de Morelos was analyzed. The enzyme determination of aspartate aminotransferase, alanine aminotransferase, and gamma glutamyltransferase as metabolic markers of ethanol, as well as the carbohydrate-deficient transferrin (CDT) detected by high chromatographic liquid (up to 1.8% of CDT), allowed us to identify that 6% of the college population presented a potential risk of alcohol consumption. The use of the biochemical-analytical method overall with the psychological drug and a risk factor instrument established by the Universidad Autónoma del Estado de Morelos permit us to identify students whose substance abuse consumption puts their terminal efficiency at risk as well as their academic level. The timely detection on admission to college can monitor and support a student consumer's substance abuse.

  6. Nuevos escenarios de la migración México-Estados Unidos. Las consecuencias de la guerra antiinmigrante

    PubMed Central

    MASSEY, Douglas S.; PREN, Karen A.; DURAND, Jorge

    2010-01-01

    La historia de la migración México-Estados Unidos se caracteriza por una serie de periodos durante los cuales los patrones migratorios se transforman y evolucionan como respuesta a los cambios en la política migratoria de Estados Unidos. En la década de 1990 se dio uno de estos cambios, lo que provocó el paso de la ‘era de la contradicción’ a la ‘era de la marginalización’. Actualmente, un gran número de migrantes indocumentados permanecen al margen de la ley, precisamente en un periodo en el que las penas se han incrementado y la persecución ha alcanzado niveles récord. De manera cada vez más notoria, los migrantes indocumentados, por la represión interna y fronteriza, quedan obligados a romper los lazos que los vinculaban con sus lugares de destino, pero al mismo tiempo se sienten cada vez más extraños en una tierra donde la aplicación de políticas antiinmigrantes es cosa de todos los días, lo que los sitúa en una posición de marginalización y gran vulnerabilidad. PMID:21209790

  7. The Prince, the Captain and "The State": An Examination of the Mesquita Family Ownership of "O Estado de Sao Paulo" to 1969.

    ERIC Educational Resources Information Center

    Etsinger, Jean

    Julio Mesquita joined the staff of "O Estado de Sao Paulo" in 1885 and became a director in 1891, when he also began his first term as a deputy of the Sao Paulo state assembly. Until his death in 1927, Mesquita guided the newspaper's growth in all respects--editorial, political, technological, and economic. Julio de Mesquita Filho…

  8. Petrogenesis of fertile mantle peridotites from the Monte del Estado massif (southwest Puerto Rico): a preserved section of Proto-Caribbean oceanic lithospheric mantle?

    NASA Astrophysics Data System (ADS)

    Marchesi, Claudio; Jolly, Wayne T.; Lewis, John F.; Garrido, Carlos J.; Proenza, Joaquín. A.; Lidiak, Edward G.

    2010-05-01

    The Monte del Estado massif is the largest and northernmost serpentinized peridotite belt in southwest Puerto Rico. It is mainly composed of spinel lherzolite and minor harzburgite with variable clinopyroxene modal abundances. Mineral and whole rock major and trace element compositions of peridotites coincide with those of fertile abyssal peridotites from mid ocean ridges. Peridotites lost 2-14 wt% of relative MgO and variable amounts of CaO by serpentinization and seafloor weathering. HREE contents in whole rock indicate that the Monte del Estado peridotites are residues after low to moderate degrees (2-15%) of fractional partial melting in the spinel stability field. However, very low LREE/HREE and MREE/HREE in clinopyroxene cannot be explained by melting models of a spinel lherzolite source and support that the Monte del Estado peridotites experienced initial low fractional melting degrees (~ 4%) in the garnet stability field. The relative enrichment of LREE in whole rock is not due to secondary processes but probably reflects the capture of percolating melt fractions along grain boundaries or as microinclusions in minerals, or the presence of exotic micro-phases in the mineral assemblage. We propose that the Monte del Estado peridotite belt represents a section of ancient Proto-Caribbean (Atlantic) lithospheric mantle originated by seafloor spreading between North and South America in the Late Jurassic-Early Cretaceous. This portion of oceanic lithospheric mantle was subsequently trapped in the forearc region of the Greater Antilles paleo-island arc generated by the northward subduction of the Caribbean plate beneath the Proto-Caribbean ocean. Finally, the Monte del Estado peridotites belt was emplaced in the Early Cretaceous probably as result of the change in subduction polarity of the Greater Antilles paleo-island arc without having been significantly modified by subduction processes.

  9. Desarrollo de fotonovelas para concienciar sobre trastornos de la conducta alimentaria en latinos en los Estados Unidos

    PubMed Central

    Reyes-Rodríguez, Mae Lynn; García, Marissa; Silva, Yormeri; Sala, Margarita; Quaranta, Michela; Bulik, Cynthia M.

    2016-01-01

    Resumen El objetivo de este estudio fue desarrollar fotonovelas, un tipo de novela gráfica popular en la población latina, para crear conciencia y educar sobre los trastornos de la conducta alimentaria (TCA). Cuatro caricaturas ilustradas y guiones adaptados para adultos y adolescentes de ambos sexos fueron presentados en discusiones focales y en una entrevista de profundidad. Diecisiete latinos adultos (14 mujeres; 3 hombres) y 10 adolescentes (9 féminas; 1 varón) participaron en el estudio. Los participantes encontraron las fotonovelas interesantes y que captaban más la atención que los folletos tradicionales. El uso del espanglish y la clarificación de las diferencias entre los TCA fueron sugeridos por las adolescentes femeninas. Los adultos varones sugirieron cambiar el título, que se enfocara en las consecuencias en la salud de los TCA para que llame la atención en los hombres a leer la historia. Basado en la aceptación encontrada en este estudio, la fotonovela pudiera ser una avenida prometedora para crear conciencia y educar a la comunidad latina sobre los TCA en los Estados Unidos. PMID:27313838

  10. Geospatial tools for the identification of a malaria corridor in Estado Sucre, a Venezuelan north-eastern state.

    PubMed

    Delgado-Petrocelli, Laura; Camardiel, Alberto; Aguilar, Víctor Hugo; Martinez, Néstor; Córdova, Karenia; Ramos, Santiago

    2011-05-01

    Landscape ecology research relies on frameworks based on geographical information systems (GIS), geostatistics and spatial-feature relationships. With regard to health, the approach consists of systems analysis using a set of powerful tools aimed at the reduction of community vulnerability through improved public policies. The north-oriental malaria focus, one of five such foci in Venezuela, situated in the north-eastern part of the Estado Sucre state, unites several social and environmental features and functions as an epidemiological corridor, i.e. an endemic zone characterised by permanent interaction between the mosquito vector and the human host allowing a continuous persistence of the malaria lifecycle. A GIS was developed based on official cartography with thematic overlays depicting malaria distribution, socio-economic conditions, basic environmental information and specific features associated with the natural wetlands present in the area. Generally, malaria foci are continuously active but when the malaria situation was modelled in the north-oriental focus, a differential, spatio-temporal distribution pattern situation was found, i.e. a situation oscillating between very active and dormant transmission. This pattern was displayed by spatial and statistical analysis based on the model generated in this study and the results were confirmed by municipal and county malaria records. Control of malaria, keeping the incidence at a permanently low level within the regional population, should be possible if these results are taken into account when designing and implementing epidemiological surveillance policies.

  11. Deglacial environmental changes on Isla de los Estados (54.4°S), southeastern Tierra del Fuego

    NASA Astrophysics Data System (ADS)

    Unkel, Ingmar; Björck, Svante; Wohlfarth, Barbara

    2008-08-01

    The island of Isla de los Estados is situated at 54.5°S, 64°W, east of Argentinian Tierra del Fuego, and is located in a sensitive geographic position in relation to the zonal circulation between Antarctica and South America. Its terrestrial records of the last deglaciation, recording atmospheric conditions but within an oceanic setting, can help to clarify changes of regional circulation patterns, both atmospheric and marine. Here, we present geochemical analyses from 16-10 ka cal BP of a peat core from Lago Galvarne Bog at the northern coast of the island, and a lake sediment core from Laguna Cascada 3 km further south. The data comprise TC, TN, loss on ignition analyses and continuous XRF scanning on both cores as well as age-depth modeling based on AMS- 14C dating. Deglaciation and onset of peat formation in the coastal areas began before 16 ka cal BP followed by a rapid glacial retreat and the start of lacustrine sedimentation further inland. Data suggest initially windy conditions with permafrost succeeded by gradually warmer and wetter conditions until ca 14.5 ka cal BP. The warming trend slows down until ca 13.5 ka cal BP, followed by arid conditions culminating around 12.8 ka cal BP. Our data suggest fairly warm conditions and the establishment of denser peat and forest vegetation ca 10.6 ka cal BP, contemporaneous with the onset of the Antarctic thermal optimum. This indicates large-scale shifts in the placement of zonal flow and the Westerlies at the beginning of the Holocene.

  12. Global Vulnerability Assessment in Santa María Tixmadeje, Estado de México, México

    NASA Astrophysics Data System (ADS)

    Monroy Salazar, S.; Novelo-Casanova, D. A.

    2010-12-01

    Santa María Tixmadejé (SMT), Estado de México, Mexico is a town located very close to the Acambay-Tixmadejé fault. This fault is located in the middle of the Trans Volcanic Belt in the center of the Mexican territory and generated a large seismic event in 1912 with magnitude 6.9 which combined with the local vulnerability, caused a disaster. In this work we measure the different vulnerabilities of the SMT community: structural, economical, social and educational. In addition, we determinate the total vulnerability, by summing all estimated vulnerabilities, for the critical facilities identified in this town. Vulnerability was determined using the methodology proposed by National Oceanic Atmospheric Administration (NOAA) and by Disaster Prevention National Center (CENAPRED). Besides, we considered a minimum sample statistically significant of the total houses with a random sampling for our survey. Our results indicate that 50% of the critical facilities have high and very high and the other 50% between low and moderate level of total vulnerability. The results for independent vulnerabilities are as follows: (1) Near to 75% of the community has high and very high level of social vulnerability and the range for the another 25% is between low and moderate; (2) About 43% of the community has high and very high economical vulnerability and 57% low and moderate; (3) Approximately 38% of the population has high and very high educational vulnerability. The 62% present low and moderate vulnerability; and (4) About 42% of the community has very high structural vulnerability and 58% between low and moderate.

  13. Assessing landslide susceptibility, hazards and sediment yield in the Río El Estado watershed, Pico de Orizaba volcano, Mexico

    NASA Astrophysics Data System (ADS)

    Legorreta Paulin, G.; Bursik, M. I.; Lugo Hubp, J.; Aceves Quesada, J. F.

    2014-12-01

    This work provides an overview of the on-going research project (Grant SEP-CONACYT # 167495) from the Institute of Geography at the National Autonomous University of Mexico (UNAM) that seeks to conduct a multi-temporal landslide inventory, analyze the distribution of landslides, and characterize landforms that are prone to slope instability by using Geographic Information Systems (GIS). The study area is the Río El Estado watershed that covers 5.2 km2 and lies on the southwestern flank of Pico de Orizaba volcano.The watershed was studied by using aerial photographs, fieldwork, and adaptation of the Landslide Hazard Zonation Protocol of the Washington State Department of Natural Resources, USA. 107 gravitational slope failures of six types were recognized: shallow landslides, debris-avalanches, deep-seated landslides, debris flows, earthflows, and rock falls. This analysis divided the watershed into 12 mass-wasting landforms on which gravitational processes occur: inner gorges, headwalls, active scarps of deep-seated landslides, meanders, plains, rockfalls, non-rule-identified inner gorges, non-rule-identified headwalls, non-rule-identified converging hillslopes and three types of hillslopes classified by their gradient: low, moderate, and high. For each landform the landslide area rate and the landslide frequency rate were calculated as well as the overall hazard rating. The slope-stability hazard rating has a range that goes from low to very high. The overall hazard rating for this watershed was very high. The shallow slide type landslide was selected and area and volume of individual landslides were retrieved from the watershed landslide inventory geo-database, to establish an empirical relationship between area and volume that takes the form of a power law. The relationship was used to estimate the total volume of landslides in the study area. The findings are important to understand the long-term evolution of the southwestern flank stream system of Pico de

  14. Consensus document for the diagnosis and treatment of idiopathic pulmonary fibrosis: Joint Consensus of Sociedade Portuguesa de Pneumologia, Sociedade Portuguesa de Radiologia e Medicina Nuclear e Sociedade Portuguesa de Anatomia Patológica.

    PubMed

    Robalo Cordeiro, C; Campos, P; Carvalho, L; Campainha, S; Clemente, S; Figueiredo, L; Jesus, J M; Marques, A; Souto-Moura, C; Pinto Basto, R; Ribeiro, A; Serrado, M; Morais, A

    2016-01-01

    Idiopathic pulmonary fibrosis is a rare interstitial lung disease included in the Idiopathic Interstitial Pneumonias group. Although several potential risk factors have been described, it is a progressive fibrosing disease of unknown cause affecting mainly adults over 50 years and associated with a poor prognosis, reflected in a median survival of 2-3 years after diagnosis. The concept of a multidisciplinary working group for the diagnosis of idiopathic pulmonary fibrosis is based on the need to have experienced pulmonologists, radiologists and pathologists in the evaluation and correct treatment of the disease, and requires the use of all available data about individual patients, standardized (largely through High Resolution Computed Tomography and pathology when needed) as well as non-standardized data (laboratory, serology and biomarkers). This approach helps to increase diagnostic accuracy and is an internationally accepted recommendation. In regard to therapy, the situation has changed radically since the publication of the ATS/ERS/JRS/ALAT 2011 guidelines on the diagnosis and management of idiopathic pulmonary fibrosis where it was stressed that no proven therapy exists for this disease. Currently besides non-pharmacological treatment, therapy of complications and comorbidities and palliative care, nintedanib and pirfenidone, two compounds with pleiotropic mechanisms of action, are to date, the two drugs with confirmed efficacy in slowing functional decline and disease progression in idiopathic pulmonary fibrosis patients.

  15. Preparación de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional*

    PubMed Central

    Al-rousan, Tala M.; Rubenstein, Linda M.; Wallace, Robert B.

    2015-01-01

    Objetivos. Nos propusimos determinar el grado de preparación frente a los desastres naturales de los adultos mayores en los Estados Unidos y evaluar los factores que pueden afectar negativamente la salud y la seguridad durante este tipo de incidentes. Métodos. Obtuvimos una muestra de adultos de 50 años en adelante (n = 1 304) de la encuesta del 2010 del Estudio de la Salud y la Jubilación (HRS por su sigla en inglés). La encuesta recogió datos sobre las características demográficas generales, el estado de discapacidad o las limitaciones funcionales, y también sobre factores y comportamientos relacionados con la preparación frente a los desastres. Calculamos una puntuación global de preparación mediante indicadores individuales a fin de evaluar el grado de preparación general. Resultados. La media de la edad de los participantes (n = 1 304) fue de 70 años (desviación estándar [DE] = 9,3). Solo 34,3% informaron que habían participado en un programa formativo o que habían leído materiales sobre la preparación para los desastres. Casi 15% indicaron que usaban dispositivos médicos eléctricos que podían correr riesgo de no funcionar si se interrumpiera el suministro eléctrico. La puntuación de preparación indicó que la edad más avanzada, la discapacidad física y el menor nivel de escolaridad y de ingresos se asociaban independiente y significativamente a un grado de preparación general inferior. Conclusiones. A pesar de la mayor vulnerabilidad ante los desastres y del número cada vez mayor de adultos mayores en los Estados Unidos, muchos de los problemas sustanciales que encontramos son remediables y requieren atención en los sectores de la sociedad dedicados a la atención clínica, a la salud pública y al manejo de situaciones de emergencia.

  16. Allele frequencies of the 15 AmpF/Str Identifiler loci in the population of Metztitlán (Estado de Hidalgo), México.

    PubMed

    Gorostiza, A; González-Martín, A; Ramírez, C López; Sánchez, C; Barrot, C; Ortega, M; Huguet, E; Corbella, J; Gené, M

    2007-03-02

    The 15 AmpF/STR Identifiler loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818 and FGA) were analyzed in the sample of 180 unrelated autochthonous healthy adults born in Meztitlán City from the valley of Metztitlán (Estado de Hidalgo, México). The agreement with Hardy-Weinberg equilibrium was confirmed for all loci. From the forensic point of view, the heterozygosity value, power of discrimination and the a priori chance of exclusion were calculated.

  17. Las propiedades de las estrellas extrañas en el marco de una nueva ecuación de estado para la materia extraña

    NASA Astrophysics Data System (ADS)

    Lugones, G.; Benvenuto, O. G.

    Se estudian las propiedades generales de las estrellas constituídas por materia extraña (ME) en el marco de una nueva ecuación de estado (EOS) en la que consideramos la masa de los quarks como dependiente del número medio de bariones por unidad de volumen. Se asume esta dependencia de forma que los quarks sean livianos (pesados) a densidades altas (bajas). En esta aproximación, la EOS de la ME es similar a la predicha por el modelo de la Bolsa del MIT, pero es significativamente mas dura a bajas densidades. Esta propiedad modifica las propiedades de las estrellas extrañas en forma notable. Encontramos que, con esta nueva EOS, los objetos pueden ser más masivos que en el caso de la EOS de la bolsa del MIT y que, además, pueden presentar mayores redshifts gravitatorios en hasta un 10%. En el caso de las oscilaciones radiales de estos objetos, calculamos la relación período vs. redshift gravitacional y encontramos una expresión analítica simple para el caso de las oscilaciones de objetos de baja masa. Encontramos que, aún con hipótesis muy diferentes en cuanto a la ecuación de estado de la materia extraña, las propiedades generales de estos objetos no se ve afectada en forma fundamental, y, por lo tanto, no deberían ser muy diferentes de las aquí expuestas.

  18. La inserción en el mercado laboral de los inmigrantes latinos en España y en los Estados Unidos: Diferencias por país de origen y estatus legal

    PubMed Central

    Connor, Phillip; Massey, Douglas

    2013-01-01

    Resumen Este artículo compara los resultados económicos entre los inmigrantes latinoamericanos en España y Estados Unidos. Detectamos un efecto de selección por el que la mayoría de los inmigrantes latinoamericanos en España proceden de Sudamérica de un entorno de clases medias, mientras la mayoría de los inmigrantes que van a los Estados Unidos son centroamericanos de clase baja. Este efecto de selección explica las diferencias transnacionales en la probabilidad de empleo, logro ocupacional y salarios obtenidos. A pesar de las diferencias en los orígenes y las características de los latinoamericanos en ambos países, los factores demográficos, humanos y de capital social parecen operar de forma similar en ambos países; y cuando los modelos se estiman separadamente por estatus legal, descubrimos que los efectos se acentúan más entre los inmigrantes irregulares cuando se los compara con los regulares, especialmente en Estados Unidos. PMID:24532857

  19. Description of the population structure and genetic diversity of tuberculosis in Estado de México, a low prevalence setting from Mexico.

    PubMed

    Zenteno-Cuevas, Roberto; Mendoza-Damián, Fabiola; Muñoz, Irving Cansino; Enciso-Moreno, Leonor; Pérez-Navarro, Lucia Monserrat; Ramírez-Hernández, Ma Dolores; Vázquez-Medina, Karen; Widrobo-García, Lorena; Lauzardo, Michael; Enciso-Moreno, José Antonio

    2015-02-01

    In order to identify the genetic characteristics of the strains of mycobacteria circulating in the Estado de México, one of the states with the lowest prevalence of tuberculosis in Mexico, spoligotyping and 12-loci MIRU-VNTR typing were used to genotype tuberculosis clinical isolates. The average age of the 183 patients analyzed was 50 (± 17) years, drug resistance was noted in 57 (31%) and multidrug resistance in 22 (12%) individuals. The results from the isolates recovered showed that 80% were located in four major Euro-American lineages: Haarlem (17%), LAM (15%), T (20%) and X (29%). Other lineages found in lower proportions were: EAI, S, Beijing, West African, Turkey, Vole and Bovis. Eighteen isolates were orphans. Only 57 isolates were grouped in nine clusters and the SIT119 (X1) showed the highest number of members (23). The LAM lineage showed an increased risk for development of drug resistance (RR=4, IC: 95%: 1.05-14.2, p = 0.03). Despite the important prevalence of four major lineages found and the diversity of strains circulating in the population, we found the presence of one of the largest populations of isolates clustered to the X lineage in a setting from a Latin American country.

  20. Analysis of the El Niño/La Niña-Southern Oscillation variability and malaria in the Estado Sucre, Venezuela.

    PubMed

    Delgado-Petrocelli, Laura; Córdova, Karenia; Camardiel, Alberto; Aguilar, Víctor H; Hernández, Denise; Ramos, Santiago

    2012-09-01

    The last decade has seen an unprecedented, worldwide acceleration of environmental and climate changes. These processes impact the dynamics of natural systems, which include components associated with human communities such as vector-borne diseases. The dynamics of environmental and climate variables, altered by global change as reported by the Intergovernmental Panel on Climate Change, affect the distribution of many tropical diseases. Complex systems, e.g. the El Niño/La Niña-Southern Oscillation (ENSO), in which environmental variables operate synergistically, can provoke the reemergence and emergence of vector-borne diseases at new sites. This research investigated the influence of ENSO events on malaria incidence by determining the relationship between climate variations, expressed as warm, cold and neutral phases, and their relation to the number of malaria cases in some north-eastern municipalities of Venezuela (Estado Sucre) during the period 1990-2000. Significant differences in malaria incidence were found, particularly in the La Niña ENSO phases (cold) of moderate intensity. These findings should be taken into account for surveillance and control in the future as they shed light on important indicators that can lead to reduced vulnerability to malaria.

  1. Espectroscopia multi-objeto e imageamento de Abell 586 com GMOS - o estado dinâmico de um aglomerado de galáxias com arcos gravitacionais

    NASA Astrophysics Data System (ADS)

    Cypriano, E. S.; Sodrã©, L., Jr.; Kneib, J.-P.; Campusano, L.

    2003-08-01

    Nesse trabalho é apresentado um estudo do conteúdo de massa do aglomerado de galáxias A586 (z = 0.171) bem como sua distribuição espacial. Isso foi feito a partir de dados de espectroscopia multi-objeto e imageamento obtidos com o instrumento GMOS acoplado ao telescópio Gemini-Norte. A massa desse aglomerado foi estudada a partir da posição dos seus arcos gravitacionais (lentes fortes), da medida estatística da distorção na forma das galáxias de fundo (lentes fracas) e através da dispersão de velocidades de uma amostra de cerca de 30 galáxias pertencentes ao aglomerado (teorema do virial). Os dois primeiros métodos não dependem do estado dinâmico do aglomerado, enquanto que o terceiro sim. Desse modo, comparando seus resultados pode-se estimar o grau de relaxamento desse sistema. Dados de raios X presentes na literatura também serão incluídos nessa análise. Nossos resultados preliminares a partir das técnicas de lentes fracas, mostram que, supondo que a distribuição de massa desse aglomerado seja a de uma esfera isotérmica, espera-se que ele apresente uma dispersão de velocidades de 1330+/-78 km s-1, em contradicao com medidas similares feitas por Dahle et al. 2002 que encontram valores tão altos quanto 1680 km s-1. Já o estudo dinâmico resultou numa dispersão de velocidades de ~950 km s-1.

  2. Records of environmental changes during the Holocene from Isla de los Estados (54.4°S), southeastern Tierra del Fuego

    NASA Astrophysics Data System (ADS)

    Unkel, Ingmar; Fernandez, Marilen; Björck, Svante; Ljung, Karl; Wohlfarth, Barbara

    2010-12-01

    Southernmost Patagonia, located at the relatively narrow passage between Antarctica and South America, is a highly sensitive region for recording meridional and zonal changes in the pattern of oceanic and atmospheric circulation. The island of Isla de los Estados, situated at 54.5°S, 64°W, east of Argentinean Tierra del Fuego, provides an exceptional possibility, to investigate terrestrial records of atmospheric conditions in an oceanic setting during the last deglaciation and the Holocene. Here we present geochemical and diatom analyses from 10 600 to c. 1500 cal BP of one sequence (LGB) with peat, lake sediments and lagoon deposits at the northern coast of the island, and a lake sediment sequence (CAS) 3 km further inland. The data comprise TC, TN, loss on ignition analyses and continuous XRF scanning as well as age-depth modeling based on AMS- 14C dating on both cores. Diatom analysis of the CAS record complements the geochemical proxies. During the Holocene, our two sites have been impacted by two different forcings: changes in the regional climate regime largely influenced by the varying strength and position of the Southern Hemisphere Westerlies (SHW), while relative sea-level changes affected the deposits of the coastal site. In concert with the onset of the Antarctic thermal optimum, our data suggest fairly warm conditions and the establishment of denser peat and forest vegetation on the island c. 10 600 cal BP. Between 8500 and 4500 cal BP geochemistry and diatoms from the CAS record indicate stronger Westerlies at this latitude, which means higher wind speed or higher storm frequency and more precipitation, resulting in more pronounced surface run-off. After 4500 cal BP, the geochemical proxies and large changes in diatom assemblages indicate a decrease in precipitation, weaker winds and possibly cooler conditions, probably as an effect of weaker SHW and/or a latitudinal shift. The depositional environment of CAS changed from gyttja to peat around 1000

  3. Natural Hazards and Vulnerability in Valle de Chalco Solidaridad Estado de Mexico, Mexico. Case studies: El Triunfo, Avandaro and San Isidro

    NASA Astrophysics Data System (ADS)

    Ponce-Pacheco, A. B.; Novelo-Casanova, D. A.; Espinosa-Campos, O.; Rodriguez, F.; Huerta-Parra, M.; Reyes-Pimentel, T.; Benitez-Olivares, I.

    2010-12-01

    On February 5, 2010, occurred a fracture on a wall of the artificial water channel called “La Compañía (CC)” in the section of the municipality of Valle de Chalco Solidaridad (VCS), Estado de Mexico, Mexico. The dimensions of this fracture were 70m length, 20m wide and 5m height, and cause severe wastewater flooding that affected surrounding communities. This area was also impacted by a similar event in 2000 and 2005. In this study, we assess the social, economic, structural, and physical vulnerability to floods, earthquakes, subsidence, and landslides hazards in the communities of El Triunfo, San Isidro and Avandaro of VCS. This area is located in soil of the old Chalco Lake, and in recent decades has experienced a large population growth. Due to urban development and the overexploitation of aquifers, the zone is also exposed to subsidence up to 40 cm per year. For these reasons, CC is at present, well above ground level. In this research, we applied the methodology developed by the National Oceanic and Atmospheric Administration (NOAA) to assess vulnerability. As a first step, we established the level of exposure of the communities to the four main hazards. We also analyzed the economic and social vulnerability of the area using data collected from a field survey. From the total family houses in the studied communities, we estimated a minimum sample statistically significant and the households from this sample were selected randomly. We defined five levels of vulnerability: very low, low, moderate, high, and very high. Our results indicate that San Isidro is the community with the highest level of structural vulnerability, as for the physical vulnerability it was found that the homes most affected by flooding are those located close to CC but we did not found a direct relationship between the physical vulnerability and structural vulnerability. The main hazard to which the zone of study is exposed is flooding because its period of recurrence is about five

  4. An overview of a GIS method for mapping landslides and assessing landslide hazards at Río El Estado watershed, on the SW flank of Pico de Orizaba Volcano, Mexico

    NASA Astrophysics Data System (ADS)

    Legorreta Paulin, G.; Bursik, M. I.; Contreras, T.; Polenz, M.; Ramírez Herrera, M.; Paredes Mejía, L.; Arana Salinas, L.

    2012-12-01

    This poster provides an overview of the on-going research project (Grant SEP-CONACYT no 167495) from the Institute of Geography at the National Autonomous University of Mexico (UNAM) that seeks to conduct a multi-temporal landslide inventory, produce a landslide susceptibility map, and estimate sediment production by using Geographic Information Systems (GIS). The Río El Estado watershed on the southwestern flank of Pico de Orizaba volcano, the highest mountain in Mexico, is selected as a study area. The catchment covers 5.2 km2 with elevations ranging from 2676.79 to 4248.2 m a.s.l. and hillslopes between 0° and 56°. The stream system of Río El Estado catchment erodes Tertiary and Quaternary lavas, pyroclastic flows, and fall deposits. The geologic and geomorphologic factors in combination with high seasonal precipitation, high degree of weathering, and steep slopes predispose the study area to landslides. The methodology encompasses three main stages of analysis to assess landslide hazards: Stage 1 builds a historic landslide inventory. In the study area, an inventory of more than 170 landslides is created from multi-temporal aerial-photo-interpretation and local field surveys to assess landslide distribution. All landslides were digitized into a geographic information system (GIS), and a spatial geo-database of landslides was constructed from standardized GIS datasets. Stage 2 Calculates the susceptibility for the watershed. During this stage, Multiple Logistic Regression and SINMAP) will be evaluated to select the one that provides scientific accuracy, technical accessibility, and applicability. Stage 3 Estimate the potential total material delivered to the main stream drainage channel by all landslides in the catchment. Detailed geometric measurements of individual landslides visited during the field work will be carried out to obtain the landslide area and volume. These measurements revealed an empirical relationship between area and volume that took the

  5. Multi-proxy analyses of a peat bog on Isla de los Estados, easternmost Tierra del Fuego: a unique record of the variable Southern Hemisphere Westerlies since the last deglaciation

    NASA Astrophysics Data System (ADS)

    Björck, Svante; Rundgren, Mats; Ljung, Karl; Unkel, Ingmar; Wallin, Åsa

    2012-05-01

    We have analyzed an almost 14,000 year old peat sequence on the island of Isla de los Estados (55° S, 64° W), east of Tierra del Fuego, in the core of the Southern Hemisphere Westerlies. A multitude of methods have been used: high resolution 14C dating; detailed lithologic descriptions including humification degree; loss on ignition; magnetic susceptibility; bulk density; pollen and spore analysis and determination of Aeolian sand influx. By combining proxies for wind and precipitation we have been able to reconstruct how the westerlies have varied over time in the Atlantic sector of the Southern Ocean. It shows that this westerly wind belt was most intense at the onset of the record, 13,600-13,200 cal BP, coinciding with the mid to late part of the Antarctic Cold Reversal, followed by a gradual decline. At 12,200 cal BP the westerlies seem to have shifted to a position south of Tierra del Fuego and this phase, the calmest and driest period on the island throughout the sequence, ended at 10,000 cal BP when the westerlies moved equatorward again. Since then the westerlies have been present but with a variable impact on the 55° S latitude of the Atlantic. Mostly conditions have been fairly similar to today, but occasionally with a wider or narrower and/or weaker or stronger wind belt. At 7200 cal BP wind intensity began to increase and between 4500 and 3500 cal BP these southern latitudes experienced a distinct wind and precipitation maximum, both in terms of perseverance and intensity. Our results show a both wide and strong wind belt, with possible niveo-aeolian activity in Tierra del Fuego in winter, and possibly creating milder summers around the Antarctic Peninsula. In the later part of the Holocene, expansion-contraction phases of the wind belt, especially in winter, seem to have been a common phenomenon.

  6. Estudio de la fotoabsorción y fotoionización de la molécula de alta relevancia atmosférica no a través de los estados Rydberg con la metodología MQDO

    NASA Astrophysics Data System (ADS)

    Bustos, E.; Velasco, A. M.; Martín, I.; Lavín, C.

    Los procesos de fotoionización son de una importancia fundamental [1] y encuentran aplicación en un gran número de contextos científicos: Astrofísica [2], química de las radiaciones, biología. Los investigadores de dichos campos, necesitan de valores de fiables de secciones eficaces para la fotoionización parcial, la Fotoabsorción, así como para los procesos de fotofragmentación en amplios intervalos espectrales, particularmente en estudios de modelización [3-5]. En este trabajo se ha centrado la atención sobre el oxido nítrico, que se ha considerado apropiado y relevante por varios motivos: por el trascendental papel que representa en la física y química de la alta atmosfera [6], aparte de por estar íntimamente relacionado con los problemas de contaminación. Los procesos de recombinación disociativa [7] del NO, donde los estados Rydberg se encuentran directamente implicados, son relevantes, por ejemplo, en las regiones E y F de la ionosfera [7]. En este trabajo se estudia la fotoionización del NO desde el estado fundamental con la versión molecular del método del orbital de defecto cuántico (MQDO). Para ello se calcula el diferencial de las fuerzas de oscilador parciales que constituyen los canales de fotoionización del NO desde el estado fundamental. La continuidad del diferencial de fuerza de oscilador calculada a través del umbral de fotoionización, esto es, en las regiones del espectro discreta y del continua, se adopta como criterio de calidad la escasez de datos comparativos [8].

  7. Physical, Structural and Operational Vulnerability of Critical Facilities in Valle de Chalco Solidaridad, Estado de Mexico, Mexico. Case of study: Avándaro, San Isidro and El Triunfo

    NASA Astrophysics Data System (ADS)

    Garcia Payne, D. G.; Novelo-Casanova, D. A.; Ponce-Pacheco, A. B.; Espinosa-Campos, O.; Huerta-Parra, M.; Reyes-Pimentel, T.; Rodriguez, F.; Benitez-Olivares, I.

    2010-12-01

    Valle de Chalco Solidaridad is located in Mexico City Metropolitan Area in Estado de Mexico, Mexico. In this town there is a sewage canal called “La Compañía”. A wall of this canal collapsed on February 5, 2010 due to heavy rains creating the flooding of four surrounding communities. It is important to point out that this area is frequently exposed to floods. In this work, we consider a critical facility as an essential structure for performance, health care and welfare within a community or/and as a place that can be used as shelter in case of emergency or disaster. Global vulnerability (the sum of the three measured vulnerabilities) of the 25 critical facilities identified in the locations of Avándaro, San Isidro and El Triunfo was assessed using the Community Vulnerability Assessment Tool developed by the National Oceanic and Atmospheric Administration (NOAA). For each critical facility we determined its operational, structural and physical vulnerabilities. For our analysis, we considered the four main natural hazards to which Valle de Chalco is exposed: earthquakes, floods, landslides and sinking. We considered five levels of vulnerability using a scale from 1 to 5, where values range from very low to very high vulnerability, respectively. A critical facilities database was generated by collecting general information for three categories: schools, government and church. Each facility was evaluated considering its location in relation to identified high-risk areas. Our results indicate that in average, the global vulnerability of all facilities is low, however, there are particular cases in which this global vulnerability is high. The average operational vulnerability of the three communities is moderate. The global structural vulnerability (sum of the structural vulnerability for the four analyzed hazards) is moderate. In particular, the structural vulnerability to earthquakes is low, to landslides is very low, to flooding is moderate and to sinking is

  8. Medicina integrativa en América: De qué forma se está practicando la medicina integrativa en los centros clínicos en los Estados Unidos

    PubMed Central

    Horrigan, Bonnie; Lewis, Sheldon; Abrams, Donald I.; Pechura, Constance

    2012-01-01

    RESUMEN EJECUTIVO El impulso para desarrollar e implementar estrategias de medicina integrativa está enraizado en el deseo de mejorar la atención al paciente. The Bravewell Collaborative, una organización sin ánimo de lucro dedicada a la mejora de la atención sanitaria, define la medicina integrativa como “un enfoque de la medicina que coloca al paciente en el centro y se dirige al conjunto completo de influencias físicas, emocionales, mentales, sociales, espirituales y ambientales que afectan a la salud de la persona. Con una estrategia personalizada que considera las condiciones, necesidades y circunstancias únicas del paciente, utiliza las intervenciones más apropiadas de una variedad de disciplinas científicas para curar la afección y la enfermedad y ayudar a las personas a recobrar y mantener una salud óptima”. En las pasadas dos décadas, se ha documentado un número creciente de centros clínicos que proporcionan medicina integrativa, el número de facultades y escuelas médicas que enseñan estrategias integrativas, el número de investigadores que estudian intervenciones integrativas, y el número de pacientes que solicitan cuidados integrativos. Pero se desconocía si la medicina integrativa se estaba ofreciendo de manera igual, similar, o dispar. Además, mientras que los estudios anteriores se centraban en la prevalencia y el uso de la medicina complementaria o alternativa (MCA) por parte de los pacientes1,2 o de los médicos en hospitales3, enumerando la utilización de terapias MCA individuales, se había recogido muy poca información con respecto a la práctica real de la medicina integrativa que, por definición, trata a la persona en su conjunto. En 2011, The Bravewell Collaborative encargó una encuesta para determinar la forma en que la medicina integrativa se estaba practicando en los Estados Unidos: (1) describiendo las poblaciones de pacientes y las afecciones sanitarias tratadas más habitualmente; (2) definiendo las pr

  9. Sobre el estado evolutivo de β Pictoris

    NASA Astrophysics Data System (ADS)

    Brunini, A.; Benvenuto, O. G.

    Desde el descubrimiento de fuertes excesos infrarrojos en β Pictoris, esta estrella ha sido muy estudiada y es considerada candidata a poseer un sistema planetario propio. β Pic está rodeada de un disco asimétrico de polvo que se observa de canto y que esta vacío a distancias <= 40 AU. Esto se considera una fuerte evidencia en favor de la presencia de (al menos) un planeta gigante. Recientemente se han observado líneas de material circunestelar que se han interpretado como consecuencia de la caída de objetos cometarios sobre esta estrella. Recientemente se ha utilizado la existencia del disco de polvo para atribuir una edad corta (pre - secuencia principal) a βPic. Sin embargo, la evaporación de estos cometas provee suficiente polvo como para explicar la presencia del disco observado sin necesidad de edades cortas. En este trabajo mostramos que la comparación entre la tasa de impactos cometarios estimada en el Sistema Solar para diferentes etapas de su evolución y los datos observados en β Pic indica edades avanzadas para β Pic. Esta estimación debe tomarse con cautela ya que depende de la estructura de los sistemas planetarios. Además mostramos que, desde el punto de vista de la evolución estelar y con las incertezas presentes en la luminosidad y la temperatura efectiva, existe un continuo de edades posible para β Pic. Sin embargo, empleando los datos provenientes de los flujos cometarios encontramos que una edad prolongada es consistente con ambos tratamientos.

  10. Entre dois mundos: vida quotidiana de criancas portuguesas na america [Between Two Worlds: The Daily Life of Portuguese Children in America].

    ERIC Educational Resources Information Center

    de Meneses, Fernando

    This Portuguese reader with accompanying teacher's guide describes the culture shock that Portuguese children and their families face when they immigrate to North America. The reader is divided into 75 short stories about the families that come from the rural areas of Portugal where there has been little industrialization. The purpose of the…

  11. Entre dois mundos: vida quotidiana de criancas portuguesas na america [Between Two Worlds: The Daily Life of Portuguese Children in America].

    ERIC Educational Resources Information Center

    de Meneses, Fernando

    This Portuguese reader with accompanying teacher's guide describes the culture shock that Portuguese children and their families face when they immigrate to North America. The reader is divided into 75 short stories about the families that come from the rural areas of Portugal where there has been little industrialization. The purpose of the…

  12. Reforma Ortografica, Planejamento e Difusao Linguistica: O Caso da Lingua Portuguesa (Orthographic Reform, Planning, and Linguistic Diffusion: The Case of Portuguese).

    ERIC Educational Resources Information Center

    Schmitz, John Robert

    1998-01-01

    Suggests that the Luso-Brazilian Accord is a strategy to spread the Portuguese language in Africa, particularly in the former colonies of Angola, Mozambique, Guinea-Bissau, Cape Verde, and Sao Tome e Principe, and to construct and solidify a community of lusophone nations in geopolitical terms in world affairs. Language planning in these countries…

  13. Reforma Ortografica, Planejamento e Difusao Linguistica: O Caso da Lingua Portuguesa (Orthographic Reform, Planning, and Linguistic Diffusion: The Case of Portuguese).

    ERIC Educational Resources Information Center

    Schmitz, John Robert

    1998-01-01

    Suggests that the Luso-Brazilian Accord is a strategy to spread the Portuguese language in Africa, particularly in the former colonies of Angola, Mozambique, Guinea-Bissau, Cape Verde, and Sao Tome e Principe, and to construct and solidify a community of lusophone nations in geopolitical terms in world affairs. Language planning in these countries…

  14. [Contribution for the validation of the Portuguese version of EQ-5D].

    PubMed

    Ferreira, Pedro Lopes; Ferreira, Lara Noronha; Pereira, Luis Nobre

    2013-01-01

    Introdução: O EQ-5D permite a junção de duas componentes essenciais de qualquer medida de qualidade de vida relacionada com a saúde a ser usada em avaliações económicas de custo-utilidade: (i) um perfil descrevendo o estado de saúde em termos de domínios ou dimensões; e (ii) um valor numérico associado ao estado de saúde anteriormente descrito.Objectivo: A versão portuguesa do questionário EQ-5D foi finalizada em 1998, com base em normas de orientação definidas pelo Grupo EuroQol, incluindo os procedimentos de tradução e retroversão. Apesar da sua larga utilização em Portugal, até agora ainda não tinham sido publicados os estudos que conduziram inicialmente à versão portuguesa e à garantia de aceitabilidade, fiabilidade e validade. O propósito do presente artigo é, assim, documentar estes primeiros valores referentes à versão portuguesa do EQ-5D.Material e Métodos: Foram utilizadas três amostras diferentes: uma primeira com 1.500 indivíduos representativa da populaçãoportuguesa; uma segunda com 140 indivíduos apenas destinada ao teste da fiabilidade; e uma terceira amostra com 643 indivíduos doentes com cataratas, asma, doença pulmonar obstrutiva crónica ou artrite reumatoide.Resultados: A aceitabilidade foi avaliada pelo número de respostas em falta. Foi também encontrado um marcado efeito de teto com grande parte da amostra a não reportar quaisquer problemas nas dimensões do EQ-5D.Discussão: A validade de construção foi testada pela análise do grau com que valores baixos de EQ-5D estavam positivamente associados ao aumento da idade, ao ser do sexo feminino, e ao estar doente, assim como a valores de dimensões da escala SF-36v2. A validade convergente foi baseada nas correlações entre valores do EQ-5D e outras escalas específicas de condição de saúde. O EQ-5D apresentou correlações moderadas a altas com outras medidas de estado de saúde e de qualidade de vida relacionada com a saúde, específicas de cada

  15. Low Adherence to Mediterranean Diet in Portugal: Pregnant Women Nutrition in Portugal and its Repercussions.

    PubMed

    Pereira-da-Silva, Luis; Pinto, Elisabete

    2016-10-01

    Introdução: Tem havido baixa adesão ao padrão da dieta mediterrânica na população portuguesa. Nesta perspectiva, procedemos à revisão crítica do estado de nutrição das mulheres em idade fértil, grávidas e recém-nascidos, em Portugal. Material e Métodos: Realizámos uma revisão narrativa crítica de estudos recentes com qualidade e inquéritos nacionais oficiais, que tivessem avaliado a dieta e estado de nutrição de mulheres em idade fértil e de grávidas portuguesas e sua influência no estado de nutrição dos respetivos fetos e recém-nascidos. Resultados: Foram selecionados e analisados cinco estudos ecológicos multinacionais que incluíram Portugal, dois inquéritos oficiais nacionais sobre disponibilidade de alimentos, sete estudos nacionais sobre dieta e estado de nutrição de mulheres em idade fértil e grávidas e cinco estudos nacionais sobre a influência de fatores nutricionais maternos no crescimento dos fetos. A prevalência de excesso de peso/obesidade em mulheres em idade fértil e grávidas aumentou substancialmente associada à diminuição da adesão à dieta mediterrânica. As variações no consumo de energia e macronutrientes na gravidez parecem não ter impacto significativo no estado de nutrição dos fetos. Pelo contrário, o excesso de peso/obesidade pré-concecional associa-se a aumento de adiposidade ao nascer e o excessivo aumento de peso na gravidez associa-se ao excesso ponderal na infância. Os fatores potencialmente relacionados com a baixa adesão à dieta mediterrânica, merecendo futura investigação, incluem políticas agrícolas da União Europeia que promoveram a produção de grupos alimentares não tipicamente mediterrânicos a baixo preço e a pouca capacidade financeira referida pela população portuguesa para aquisição de alimentos de qualidade. Conclusão: A recuperação dos hábitos dietéticos mediterrânicos tradicionais deve ser incluída em estratégias de prevenção e tratamento do

  16. El Estado de los Bosques de Puerto Rico, 2003

    Treesearch

    Thomas J. Brandeis; Eileen H. Helmer; Sonja N. Oswalt

    2003-01-01

    La cobertura forestal de Puerto Rico sigue aumentando y ahora asciende a un 57 por ciento en la isla de Puerto Rico, 85 por ciento en Vieques y 88 por ciento en Culebra. Los bosques subtropicales secos ocupan 50 346 ha, 6832 ha, 2591 ha y 6217 ha en las islas de Puerto Rico, Vieques, Culebra y Mona, respectivamente. El bosque subtropical húmedo, la zona de vida...

  17. Observatorio Pierre Auger: motivación y estado actual

    NASA Astrophysics Data System (ADS)

    Rovero, A. C.; Etchegoyen, A.; García, B.

    The Pierre Auger Observatory is aiming to understand the origin, nature and acceleration mechanisms of the most energetic cosmic rays (E>10 E18 eV). It will consist of one hybrid detector in each hemisphere, giving a total acceptance of 14200 km2 sr. The southern observatory is being constructed in Malargue, Mendoza, Argentina, and will be finished in 2006. No final statement can be made so far about any feature in the most energetic part of the spectrum. However, good candidate events were observed to have a primary energy of about 10 E20 eV.

  18. El Estado de la Educacion para los Hispanos en los Estados Unidos (The Condition of Education for Hispanics in the United States).

    ERIC Educational Resources Information Center

    Brown, George H.; And Others

    Organized into 4 chapters, the report provides tabular data portraying the educational condition for about 12 million Hispanic Americans in the United States, and shows how Hispanics compare with the majority population on various measures of educational participation and achievement. Providing an overview of Hispanic Americans in the U.S.,…

  19. The Buck Stops Where Aligning Authority to Strategy in Homeland Security

    DTIC Science & Technology

    2015-12-01

    Organizations,” Revista Portuguesa de Saúde Pública 31, no. 2 (2013): 129–144, DOI: 10.1016/j.rpsp.2012.12.006. 171 Glen Woodbury, “Measuring...of Quinn and the Miles & Snow Strategic Models: Case Studies in Health Organizations.” Revista Portuguesa de Saúde Pública 31, no. 2 (2013): 129

  20. Su Nueva Vida en los Estados Unidos. (Your New Life in the United States).

    ERIC Educational Resources Information Center

    Escobar, Vivian; And Others

    An illustrated guide to aspects of life in the United States is presented in Spanish for recent Hispanic arrivals. The guidelines address such topics as resettlement agencies, community relations and national customs, the U.S. government, local and long distance transport, mail and telephone communication systems, employment practices, the…

  1. La Hispanidad en los Estados Unidos (Spanish Influence in the United States)

    ERIC Educational Resources Information Center

    Da Silva, Zenia Sacks

    1975-01-01

    This paper recounts a brief history of Spanish exploration in the territory of the United States and surveys Spanish influence in industry, agriculture, foods, architecture and vocabulary. (Text is in Spanish.) (CK)

  2. Nebraska State Report Card, 1999-2000 = Tarjeta informativa del Estado de Nebraska, 1999-2000.

    ERIC Educational Resources Information Center

    Nebraska State Dept. of Education, Lincoln.

    This report, printed in English and Spanish versions, is the first Nebraska State Report Card. It provides a snapshot of Nebraska schools using statewide averages. Nebraska students scored better than students nationwide in reading, with 60% of Nebraska students in grades 3-4, 7-8, and 10-12 scoring above the median on a standardized reading test.…

  3. Guide for Migrants in the State of Illinois = Guia para Migrantes en el Estado de Illinois.

    ERIC Educational Resources Information Center

    Langemach, Sharon; Koepplinger, Jessica

    Prepared for migrant farmworkers traveling in the State of Illinois, the booklet, written in English and Spanish, provides basic information on (1) employment conditions--requirements of crew leaders and employers, deductions from wages, and laws regulating child labor; (2) housing--conditions of the camp grounds and of living units; (3)…

  4. One Language for the United States? (Un Idioma para Los Estados Unidos?) CSG Backgrounder.

    ERIC Educational Resources Information Center

    Ford, Mark L.

    The United States has become increasingly multilingual in recent decades, and while English is the most commonly spoken language, almost 11 percent of Americans prefer to speak another language at home. Bilingualism is promoted by governmental units at the federal, state, and local levels through a variety of programs, particularly in education…

  5. La Lengua Espanol en los Estados Unidos (The Spanish Language in the United States).

    ERIC Educational Resources Information Center

    Barnach-Calbo, Ernesto

    This report on the use of the Spanish language in the United States discusses the Spanish-speaking population, the language itself, and bilingual education in the United States. The background about the Spanish-speaking population includes the following topics: (1) "A Nations of Immigrants," (2) "The Population of the…

  6. Sistemas binarios viuda negra: conectando sus orígenes con su estado final

    NASA Astrophysics Data System (ADS)

    Benvenuto, O. G.; De Vito, M. A.; Horvath, J. E.

    ``Black widow'' systems are located in a well determined region of the plane (where is the mass of the pulsar companion and is the orbital period of the system). An attempt has been made to understand which are the mechanisms that lead to companions of ``black widows'' to be located in this region; since standard binary evolution does not provide a satisfactory response. From our evolutionary calculations; we study the path performed in the plane by a binary system to reach the state of ``black widow''. We also discuss whether there is a connection between ``redbacks'' and ``black widows''. FULL TEXT IN SPANISH

  7. Estado y rendimiento del espectrógrafo infrarrojo criogénico F2

    NASA Astrophysics Data System (ADS)

    Diaz, R. J.; Gomez, P.; Schirmer, M.; Navarrete, F.; Stephens, A.; Bosch, G.; Gaspar, G.; Camperi, J.; Gunthardt, G.

    First results related to the commissioning phase of Flamingos-2 spectrograph are reported. The available operation modes for observation and expected performance for 2014 are also presented. After the replacement of the first collimator lens; broken in 2012; a problem persisted in the optical alignment. The troubleshooting will require a new instrument refurbishing schedule; meanwhile; the available operation modes are limited to direct image and longslit spectroscopy. We found that the direct image () achieves its highest quality (0.4'') only in the inner 3' of the field and resolution drops toward the spectrum ends. The longslit mode provides for the / ranges; and for the R3k grism in the ranges ; or . We also determine the uncertainties for emission line kinematics; and study the relative flexion between the guiding system; the slit and the detector. FULL TEXT IN SPANISH

  8. Cuentos Hispanos de los Estados Unidos (Hispanic Stories of the United States).

    ERIC Educational Resources Information Center

    Olivares, Julian, Ed.

    This anthology of 21 short stories is intended for Spanish-speaking students of Spanish, other students in intermediate and advanced Spanish-language courses, and students commencing study of the Hispanic literature of the United States. Twelve of the 15 authors are, by birth or descent, of Mexican, Cuban, or Puerto Rican origin. Eight were born…

  9. Estado evolutivo de estrellas con fenómeno B[e

    NASA Astrophysics Data System (ADS)

    Aidelman, Y. J.; Cidale, L.; Borges Fernandes, M.; Kraus, M.

    The B[e] phenomenon is related to certain peculiar features observed in the spectrum of some B stars, which are mainly linked to the physical conditions of their circumstellar medium. As these stars are embedded in dense and optically thick circumstellar media, the determination of the spectral type and luminosity class of the central objects is quite difficult. As a consequence, their evolutionary stage and distances present huge uncertainties. In this work we study 4 B[e] stars and discuss their stellar fundamental parameters and evolutionary stages using the BCD spectrophotometric system. FULL TEXT IN SPANISH

  10. La Lengua Espanol en los Estados Unidos (The Spanish Language in the United States).

    ERIC Educational Resources Information Center

    Barnach-Calbo, Ernesto

    This report on the use of the Spanish language in the United States discusses the Spanish-speaking population, the language itself, and bilingual education in the United States. The background about the Spanish-speaking population includes the following topics: (1) "A Nations of Immigrants," (2) "The Population of the…

  11. Cirugía de los trastornos del comportamiento: el estado del arte

    PubMed Central

    Yampolsky, Claudio; Bendersky, Damián

    2014-01-01

    Introducción: La cirugía de los trastornos del comportamiento (CTC) se está convirtiendo en un tratamiento más común desde el desarrollo de la neuromodulación. Métodos: Este artículo es una revisión no sistemática de la historia, indicaciones actuales, técnicas y blancos quirúrgicos de la CTC. Dividimos su historia en 3 eras: la primera comienza en los inicios de la psicocirugía y termina con el desarrollo de las tícnicas estereotácticas, cuando comienza la segunda era. Ésta se caracteriza por la realización de lesiones estereotácticas. Nos encontramos transitando la tercera era, que comienza cuando la estimulación cerebral profunda (ECP) comienza a ser usada en CTC. Resultados: A pesar de los errores graves cometidos en el pasado, hoy en día, la CTC está renaciendo. Los trastornos psiquiátricos que se más frecuentemente se tratan con cirugía son: depresión refractaria, trastorno obsesivo-compulsivo y síndrome de Tourette. Además, algunos pacientes con agresividad fueron tratados quirúrgicamente. Hay varios blancos estereotácticos descriptos para estos trastornos. La estimulación vagal puede ser usada también para depresión. Conclusión: Los resultados de la ECP en estos trastornos parecen alentadores. Sin embargo, se necesitan más estudios randomizados para establecer la efectividad de la CTC. Debe tenerse en cuenta que una apropiada selección de pacientes nos ayudará a realizar un procedimiento más seguro así como también a lograr mejores resultados quirúrgicos, conduciendo a la CTC a ser más aceptada por psiquiatras, pacientes y sus familias. Se necesita mayor investigación en varios temas como: fisiopatología de los trastornos del comportamiento, indicaciones de CTC y nuevos blancos quirúrgicos. PMID:25165612

  12. Otomi de San Andres Cuexcontitlan, Estado de Mexico (Otomi of San Andres Cuexcontitlan, State of Mexico).

    ERIC Educational Resources Information Center

    Lastra, Yolanda

    This document is one of 17 volumes on indigenous Mexican languages and is the result of a project undertaken by the Archivo de Lenguas Indigenas de Mexico. This volume contains information on Otomi, an indigenous language of Mexico spoken in San Andres Cuexcontitlan, in the state of Mexico. The objective of collecting such a representative…

  13. Su Nueva Vida en los Estados Unidos. (Your New Life in the United States).

    ERIC Educational Resources Information Center

    Escobar, Vivian; And Others

    An illustrated guide to aspects of life in the United States is presented in Spanish for recent Hispanic arrivals. The guidelines address such topics as resettlement agencies, community relations and national customs, the U.S. government, local and long distance transport, mail and telephone communication systems, employment practices, the…

  14. One Language for the United States? (Un Idioma para Los Estados Unidos?) CSG Backgrounder.

    ERIC Educational Resources Information Center

    Ford, Mark L.

    The United States has become increasingly multilingual in recent decades, and while English is the most commonly spoken language, almost 11 percent of Americans prefer to speak another language at home. Bilingualism is promoted by governmental units at the federal, state, and local levels through a variety of programs, particularly in education…

  15. Búsqueda de sitio en el Noroeste Argentino: estado de avance al 2004

    NASA Astrophysics Data System (ADS)

    Recabarren, P.; Muriel, H.; Vrech, R.; García Lambas, D.; Sarazin, M.; Giovanelli, R.

    We report the activities corresponding to the site testing project that the IATE group in collaboration with ESO and IAR have developed during the last year. We report the installation of a weather station at 4600 meters over the sea level in the Macon mountain range near the small town of Tolar Grande. We discuss the adopted criteria for the election of this site as well as the future plans.

  16. Múltiples estados de desorden en el etanol sólido

    NASA Astrophysics Data System (ADS)

    Fernández-Perea, R.

    El diagrama de fases del etanol por debajo de los 169 K será presentado. Se mostrará que el etanol puede solidificarse en tres fases con diversos niveles de desorden,(como un vidrio(G), como un vidrio orientacional (OG) y como un cristal de fase rotora (RP)) además de en una fase totalmente cristalina. Las estructuras de estas tres fases serán presentadas tal y como se deducen a partir de diversas medidas de difracción de neutrones al igual que las proporciones de los isómeros de dicho material en las fases desordenadas y se compararán con los resultados de la fase cristalina y del líquido superenfriado. Igualmente diversas medidas sobre su dinámica serán presentadas, tanto de dispersión de neutrones, como de capacidad calorífica y de medidas dieléctricas y comparadas con modelos teóricos y simulaciones para tratar de explicar los procesos de relajación observados y las transiciones entre las diversas fases.

  17. [Venezuelan equine encephalitis. Determination of antibodies in the human population of Municipio Mirand, Estado Zulia, Venezuela].

    PubMed

    Ryder, S; Núñez-Camargo, J; Rangel, P; Añez, F

    1993-01-01

    With the purpose of determining antibodies prevalence against Venezuelan Equine Encephalitis Virus in the population of Puertos de Altagracia and Sabaneta de Palmas of Miranda county, Zulia State, Venezuela, 199 subjects were studied: 57 from Puertos de Altagracia and 142 from Sabaneta de Palmas. They were classified in older (42.78%) and younger (57.2%) than 15 years. The blood specimens were processed for Hemagglutination Inhibition Test using EEV antigen Goajira strain at pH 6.5. We found that all 57 specimens from Puertos de Altagracia were negative, whereas of 142 specimens from Sabaneta de Palmas 17 were positive (11.97%). Of these, one was from a subject less than 15 years-old (5.85%) and 16 from individuals more than 15 years-old (94.15%). Positive titers were higher than 1:160 in 80% of cases. Being Sabaneta de Palmas one of the most affected areas in the 1962 epidemic in the Miranda county and keeping the affected ones high positivity with elevated titers, we conclude that this population could represent an enzootic zone similar to Paez county where a similar situation, of high positivity and elevated titers, many years after the last epidemic occurred in that area, has been described.

  18. La Hispanidad en los Estados Unidos (Spanish Influence in the United States)

    ERIC Educational Resources Information Center

    Da Silva, Zenia Sacks

    1975-01-01

    This paper recounts a brief history of Spanish exploration in the territory of the United States and surveys Spanish influence in industry, agriculture, foods, architecture and vocabulary. (Text is in Spanish.) (CK)

  19. Guide for Migrants in the State of Illinois = Guia para Migrantes en el Estado de Illinois.

    ERIC Educational Resources Information Center

    Langemach, Sharon; Koepplinger, Jessica

    Prepared for migrant farmworkers traveling in the State of Illinois, the booklet, written in English and Spanish, provides basic information on (1) employment conditions--requirements of crew leaders and employers, deductions from wages, and laws regulating child labor; (2) housing--conditions of the camp grounds and of living units; (3)…

  20. Cuentos Hispanos de los Estados Unidos (Hispanic Stories of the United States).

    ERIC Educational Resources Information Center

    Olivares, Julian, Ed.

    This anthology of 21 short stories is intended for Spanish-speaking students of Spanish, other students in intermediate and advanced Spanish-language courses, and students commencing study of the Hispanic literature of the United States. Twelve of the 15 authors are, by birth or descent, of Mexican, Cuban, or Puerto Rican origin. Eight were born…

  1. Análise dos Conceitos Astronômicos Apresentados por Professores de Algumas Escolas Estaduais Brasileiras

    NASA Astrophysics Data System (ADS)

    Voelzke, Marcos Rincon; Gonzaga, Edson Pereira

    2011-12-01

    A razão para o desenvolvimento deste trabalho baseia-se no fato de que muitos professores da Educação Básica (EB) não lidam com conceitos relacionados à astronomia, e quando o fazem eles simplesmente seguem livros didáticos que podem conter erros conceituais. Como é de conhecimento geral a astronomia é um dos conteúdos a serem ensinados na EB fazendo parte dos Parâmetros Curriculares Nacionais e das Propostas Curriculares do Estado de São Paulo, mas é um fato, que vários pesquisadores apontam, a existência de muitos problemas no ensino da astronomia. Com o propósito de minimizar algumas dessas deficiências foi realizado um trabalho de pesquisa com a utilização de questionários pré e pós pesquisa, para tanto foi desenvolvido um Curso de Extensão Universitária para professores da Diretoria de Ensino Regional (DE) que abrange Mauá, Ribeirão Pires e Rio Grande da Serra (no Estado de São Paulo) com os seguintes objetivos: levantar concepções alternativas; subsidiar os professores por meio de palestras, debates e workshops, e verificar o sucesso da aprendizagem após o curso, adotando-se como referência, para a análise dos resultados, os dicionários de Língua Portuguesa (FERREIRA, 2004) e Enciclopédico de Astronomia e Astronáutica (MOURĀO, 1995). Portanto, dezesseis questões foram aplicadas antes e após o curso, assim pode-se verificar após a pesquisa que 100,0% dos professores sabiam os nomes das fases da Lua, 97,0% entenderam que o Sistema Solar é composto por oito planetas, 78,1% foram capazes de explicar como ocorre um eclipse lunar, um eclipse solar e um solstício, 72,7% sabiam como explicar a ocorrência das estações do ano; 64,5% explicaram corretamente a ocorrência do equinócio, 89,7% foram capazes de definir adequadamente o termo cometa; 63,6% definiram asteróide, 54,5% meteoro, 58,1% galáxia, e 42,4% planeta. Os resultados obtidos indicam uma aprendizagem significativa por parte dos participantes.

  2. Validation of the self-assessment of communication skills and professionalism for nurses.

    PubMed

    Pereira, Thaís Josgrilberg; Puggina, Ana Claudia

    2017-01-01

    to translate, adapt cross-culturally and validate into Brazilian Portuguese the following instrument: "Self-assessment of communication skills and professionalism in residents" for the nursing professional, and to determine if personal characteristics and performance of the nurse interfere in the self-assessment about professionalism and interpersonal communication. quantitative study. the sample consisted of 110 nurses with mean age of 32 years old (± 7.3), most of them were women (n = 80; 72.7%). The internal consistency of the scale "Autoavaliação sobre profissionalismo e comunicação interpessoal entre enfermeiro e paciente" presented moderate and satisfactory reliability (α=0,712). Factorial analysis identified four factors: Interpersonal Skills, Exchange of Information, Honesty in the Relationship and Professionalism. the instrument is valid and reliable in Portuguese and for Brazilian culture. Interpersonal Skills changed with gender and marital status. Ability to exchange information was influenced by gender and working sector. Self-assessment of professionalism changed with marital status. traduzir, adaptar culturalmente e validar para o português o instrumento Self-assessment of communication skills and professionalism in residents para o profissional enfermeiro e avaliar se características pessoais e de atuação do enfermeiro interferem na autoavaliação sobre o profissionalismo e comunicação interpessoal. estudo metodológico quantitativo. A amostra foi de 110 enfermeiros com média de idade de 32 anos (±7,3) e a maioria mulheres (n=80; 72,7%). A consistência interna da escala "Autoavaliação sobre profissionalismo e comunicação interpessoal entre enfermeiro e paciente" apresentou confiabilidade moderada e satisfatória (α=0,712). A análise fatorial identificou quatro fatores: Habilidade Interpessoal, Troca de Informação, Sinceridade na Relação e Profissionalismo. o instrumento é válido e confiável na língua portuguesa e para a

  3. Low Frequency Noise: A Major Risk Factor in Military Operation

    DTIC Science & Technology

    2003-02-01

    Vibroacoustic disease: some forensic aspects. Aviation, Space & Environmental Medicine 1999; 70 (3, Suppl): A 145-51. 5. Canas J, Martinho Pimenta AJF, Castelo...Gomes LMP, Rodriguez E, Castelo Branco NAA. Performance assurance computerized test - PACT. Revista Portuguesa de Medicina Militar 1993; 41 (1-4): 21-27...Revista Portuguesa de Medicina Militar 1992: 40(1-4): 41-45. 17. GIMOGMA. Epilepsia sintomidtica de etiologia vascular, manifestaqao da sindrome das

  4. Status and distribution of Chihuahuan Desert Grasslands in the United States and Mexico (Evaluacion del estado y distribucion de los pastizales del Desierto Chihuahuense en los Estados Unidos y Mexico)

    Treesearch

    Martha Desmond; Jennifer Atchley Montoya

    2006-01-01

    Grasslands comprise a small part of the Chihuahuan Desert but are vital to the biological diversity of the ecoregion. Characteristic grasses of the Chihuahuan Desert are tobosa (Pleuraphis mutica) and black grama (Bouteloua eriopoda) but other common species include alakali sacaton (Sporobolus airoides), big alkali sacaton (S. wrightii), mesa dropseed (S. flexuosus),...

  5. Women of Spanish Origin in the United States, 1976. La Mujer de Origen Hispano en los Estados Unidos, 1976.

    ERIC Educational Resources Information Center

    Employment Standards Administration (DOL), Washington, DC. Women's Bureau.

    The report presents data on selected social, economic, and demographic characteristics of women of Spanish origin in the United States. Derived from the population reports of the U.S. Census Bureau and the March 1973 Manpower Report of the President, the statistical data pertain to age, residence, marital status, heads of families and households,…

  6. Situacion del Chicano en las Universidades de Los Estados Unidos (Situation of the Chicano in the United States Universities).

    ERIC Educational Resources Information Center

    Dolz-Blackburn, Ines

    Chicanos attending universities in the United States are, in general, frustrated individuals. With two languages and two cultures, they feel uneasy in both and usually go to the university with an inferiority complex. In spite of these shortcomings, Chicanos are, generally, subjected to the same entrance exams and requirements as the rest of the…

  7. Bienvenido a los Estados Unidos. Una Guia para Refugiados (Welcome to the United States. A Guide for Refugees). First Edition.

    ERIC Educational Resources Information Center

    Economic and Social Research Council, Edinburgh (Scotland). Centre for Educational Sociology.

    This guidebook provides Spanish-speaking refugees being resettled in the United States with general information about what they will encounter and the services they can receive in their first months in the country. This is the Spanish version, and is available in several other languages. The book is distributed to overseas processing agencies,…

  8. Perspectiva Historica de la Educacion Bilingue en los Estados Unidos (A Historical Perspective of Bilingual Education in the United States)

    ERIC Educational Resources Information Center

    Zamora, Juan Clemente

    1978-01-01

    This article defines bilingualism and bilingual education and traces the history of bilingual education in the United States, starting with the Spanish missions in the west. (Text is in Spanish.) (NCR)

  9. Guia para su incorporacion a los Estados Unidos de America (A Guide to Resettlement in the United States. Spanish).

    ERIC Educational Resources Information Center

    Center for Applied Linguistics, Washington, DC. Refugee Service Center.

    This resettlement guide, entirely in Spanish, describes the initial stage of resettlement and the processes that refugees undergo as new arrivals. Subjects covered in this guide include pre-arrival procedures, admissions criteria, immigrant's statement of understanding, travel costs and U.S. Customs; resettlement procedures, immigrants'…

  10. Kawasaki disease: a rare pediatric pathology in Mexico. Twenty cases report from the Hospital Infantil del Estado de Sonora.

    PubMed

    Sotelo, Norberto; González, Luis Antonio

    2007-01-01

    Kawasaki disease (KD) is an etiological illness that is relatively unknown and scarcely identified in Mexico; it affects children mainly aged 1-4 years, evolves with fever, vasculitis in diverse organs, and in the heart the disease mainly affects the coronary arteries. Our aim was to inform the clinical findings and evolution of 20 patients diagnosed with KD. We reviewed the patient clinical files retrospectively and descriptively to obtain information with regard to age, sex, clinical signs, laboratory and consultory results, echocardiography findings, complications, evolution during hospitalization, followup, and out-patient ambulatory consultations. Eighteen patients were male, two were female, six developed coronary damage, two aortic mitral-valve insufficiency, one pericardial shedding, and one, myocarditis. All patients received gamma globulin treatment with aspirin, and 16 were controlled during 6-8 months after the acute medical profile. The opportune clinical diagnostic it is fundamental to establish an early treatment with gammmaglobuline to avoid injuries in the arterial coronary level. This injury may cause eventualy ischemia or myocardial infarct

  11. Rutinas para reducción de observaciones polarimétricas: evolución y estado actual

    NASA Astrophysics Data System (ADS)

    Cellone, S. A.

    I briefly review the evolution experimented by the software for reduction of observational data obtained with the CasProf photopolarimeter, ten years after its "first light" at the Jorge Sahade telescope. Our original routines for the calculation of Stokes parameters were complemented with new ones used to improve the quality of our results, and to adapt the software to different needs, in particular, to obtain polarimetric variability curves (applied to blazar studies). FULL TEXT IN SPANISH

  12. [Enterobiasis among schoolchildren in a rural population from Estado Falcón, Venezuela, and its relation with socioeconomic level].

    PubMed

    Acosta, María; Cazorla, Dalmiro; Garvett, María

    2002-09-01

    Between may and july 2001, a survey was conducted in order to investigate the prevalence and symptoms of Enterobius vermicularis infection and its relationship with the socio-economic status and household crowding of 154 schoolchildren aged 6-12 years from a rural village in Falcon State, Venezuela. The Graham technique (perianal swabs with an adhesive cellulose tape) was used to perform the parasitological diagnosis. The overall prevalence was high (57.79%). There was no difference in the prevalence between sexes (X2 = 0.005; d.f. = 1) or ages (X2 = 3.63; d.f. = 6) (p > 0.05), suggesting similar risk conditions for all individuals. Anal pruritus was the most common clinical finding (53.9%). Other less frequent manifestations were the following: perianal lesions (34.8%) and vulvovaginitis (32.6%). Graffar analysis revealed that the majority of schoolchildren belong to the poorer socioeconomic strata: IV (55.9%) and V (29.87%), with overcrowded living conditions. The correlation between E. vermicularis infection and crowding rates was found to be statistically significant (r = 0.98; p < 0.001). In the light on these results, it can be concluded that poverty, overcrowding, anal pruritus, scarcity of water, inadequate personal and community hygiene play a relevant role on the transmission dynamics and endemic maintenance of enterobiasis among schoolchildren from Sabaneta.

  13. Situacion del Chicano en las Universidades de Los Estados Unidos (Situation of the Chicano in the United States Universities).

    ERIC Educational Resources Information Center

    Dolz-Blackburn, Ines

    Chicanos attending universities in the United States are, in general, frustrated individuals. With two languages and two cultures, they feel uneasy in both and usually go to the university with an inferiority complex. In spite of these shortcomings, Chicanos are, generally, subjected to the same entrance exams and requirements as the rest of the…

  14. Hacia una adaptación cultural para el tratamiento de trastornos alimentarios en latinos en Estados Unidos

    PubMed Central

    Reyes-Rodríguez, Mae Lynn; Bulik, Cynthia M.

    2011-01-01

    Eating disorders affect all ethnic and socioeconomic groups. However, evidence based treatments for eating disorders have been developed and tested exclusively on Caucasian populations. With the purpose to develop a culturally sensitive framework for the eating disorders treatment in Latinos/as, the objectives of this work were: 1) identify and describe some of the relevant cultural elements for eating disorders in the Latino population and, 2) to draft a culturally sensitive intervention model for eating disorders in Latino population in the United States. Providing culturally sensitive treatments for Latinos with psychiatric disorders is essential to reverse public health disparities. PMID:22003472

  15. [Psychiatry and mental health in the Institutp de Seguridad Social para los Trabajadores del Estado. Philosophy of its development].

    PubMed

    Dallal y Castillo, E

    1977-01-01

    In 1972, prepaid medical care for government employees provided by their social security institute, ISSSTE, was reorganized. A division of planning and technical standards was established, within which a Department of Psychiatry was included. Psychiatric care was restructured at three levels: psychiatric hospital, psychiatric OPD at clinic and hospital level and a pilot program in community psychiatry. A three-year psychiatric residency program was established, in addition to participation in other postgraduate, in-service training and monographic courses. Systematic research was started, as well as a publications program, working relationship with other institutions and societies were enhanced. A descriptive example is Child Psychiatry. Most frequent diagnoses are reviewed, and development of services is followed in relation to pediatric departments.

  16. [Group psychotherapy. Operative groups at the Instituto del servico de seguridad Social de los Trabajadores del Estado (ISSSTE)].

    PubMed

    Margolis, J

    1977-01-01

    An operational group is defined; how operational groups theory was applied at an ISSSTE clinic is described. It is underlined how operational groups promote change around the corerstone of a "task". The vicissitudes of an operational group with four psychiatrists who worked in community psychiatry at the ISSSTE, are described.

  17. [Family psychotherapy in medical institutions of the Instituto del Servicio de Seguridad Social de los Trabajadores del Estado].

    PubMed

    Serrano, H

    1977-01-01

    The evolution of family therapy in Mexico is briefly reviewed. It is considered that the reach of this method is limited in institutions due to the lack of qualified psychotherapists with the different orientations of this speciality. The illness, as a sign of family imbalance within the humanistic concept, acquires an even if the treatment is given to the marital couple, the adolescent or the child. Family therapy helps in marital disagreements, behavior problems, anorexia, reactive depression, drug addictions, alcoholism and many other problems. The ISSSTE population has a stable location and is more or less homogeneous; in it family therapy is stimulating and possible; even though the institution imposes certain limitations to family therapy, the enthusiasm for this therapeutic method prevails.

  18. Innovative manure treatments in the USA – state of the art (Tratamientos Innovadores de estiercoles en USA - estado del arte)

    USDA-ARS?s Scientific Manuscript database

    Currently, the potential impact of manure on the environment represents one of the world agriculture’s major challenges. Treatment technologies can play an important role in the management of livestock manure by providing a more flexible approach to land application and acreage limitations and by so...

  19. Bienvenido a los Estados Unidos. Una Guia para Refugiados (Welcome to the United States. A Guide for Refugees). First Edition.

    ERIC Educational Resources Information Center

    Economic and Social Research Council, Edinburgh (Scotland). Centre for Educational Sociology.

    This guidebook provides Spanish-speaking refugees being resettled in the United States with general information about what they will encounter and the services they can receive in their first months in the country. This is the Spanish version, and is available in several other languages. The book is distributed to overseas processing agencies,…

  20. Atlas de Recursos Eólicos del Estado de Oaxaca (The Spanish version of Wind Energy Resource Atlas of Oaxaca)

    SciTech Connect

    Elliott, D.; Schwartz, M.; Scott, G.; Haymes, S.; Heimiller, D.; George, R.

    2004-04-01

    The Oaxaca Wind Resource Atlas, produced by the National Renewable Energy Laboratory's (NREL's) wind resource group, is the result of an extensive mapping study for the Mexican State of Oaxaca. This atlas identifies the wind characteristics and distribution of the wind resource in Oaxaca. The detailed wind resource maps and other information contained in the atlas facilitate the identification of prospective areas for use of wind energy technologies, both for utility-scale power generation and off-grid wind energy applications.

  1. Perspectiva Historica de la Educacion Bilingue en los Estados Unidos (A Historical Perspective of Bilingual Education in the United States)

    ERIC Educational Resources Information Center

    Zamora, Juan Clemente

    1978-01-01

    This article defines bilingualism and bilingual education and traces the history of bilingual education in the United States, starting with the Spanish missions in the west. (Text is in Spanish.) (NCR)

  2. [Risk of death 4 years after a 1st cerebral infarction: prospective study in Barquisimeto, Estado Lara, Venezuela].

    PubMed

    Poni, E; Granero, R; Escobar, B

    1995-12-01

    Stroke, the 5th. cause of death in Venezuela, has been associated to cerebral infarction. However, there is little information concerning lethality factors. 33 atherothrombotic subtype stroke patients, 31 (96%) Latino and 2(4%) white, were admitted into a prospective study to analyze the role of 11 mortality risk factors for those patients. A mortality relative risk (RR) > 1.5 or < 1 (protective) was considered clinically important if 1 was excluded from the 95% confidence interval (95%CI). The Mantel-Haenszel Chi-square procedure was use to test statistical significance (p < 0.05). Mortality RR for patients age 65 and over (RR = 2.95) and 4 year mortality RR for male patients (RR = 2.04) were clinically and statistically significant. History of high blood pressure was protective (RR = 0.62) probably due to good medical control. Cumulative mortality was higher than that of comparable studies, even from the first week of follow-up, reaching 67% at the 4th year.

  3. [Oropharyngeal morphology and food habits of Micropogonias furnieri (Pisces: Sciaenidae) in the North coast of Estado Sucre, Venezuela].

    PubMed

    Ruiz, L J; Prieto, A; Lemus, M

    2001-01-01

    Morphology of the mandibular and pharyngeal region, and the feeding habits of Micropogonias furnieri were examined in 256 male and female specimens, between 28.7 and 54.3 cm total length, collected around Morro Puerto Santo, in northeast Sucre State, Venezuela (10 degrees 45'00" N-63 degrees 8'0" W), from May 1989 to April 1990. Micropogonias furnieri has a small ventral mouth; protrusible premaxillary and dentary; first branchial arches with 21 to 27 gill rakers, generally 24 to 25; and 7 to 11 pyloric caecae. The index of vacuity was low, with mean value of 7.00%. The mean intestinal index was 0.72, indicative of carnivorous species. Analysis of frequency of occurrence, indicates preference for crustaceans (45.70%), mainly crabs (34.90%), followed by polychaetes (28.00%), fishes (11.41%) and occasionally mollusks and echinoderms (4.0 and 3.9%, respectively). The diet of this species did not vary with sex.

  4. Alternancia entre el estado de emisión de Rayos-X y Pulsar en Sistemas Binarios Interactuantes

    NASA Astrophysics Data System (ADS)

    De Vito, M. A.; Benvenuto, O. G.; Horvath, J. E.

    2015-08-01

    Redbacks belong to the family of binary systems in which one of the components is a pulsar. Recent observations show redbacks that have switched their state from pulsar - low mass companion (where the accretion of material over the pulsar has ceased) to low mass X-ray binary system (where emission is produced by the mass accretion on the pulsar), or inversely. The irradiation effect included in our models leads to cyclic mass transfer episodes, which allow close binary systems to switch between one state to other. We apply our results to the case of PSR J1723-2837, and discuss the need to include new ingredients in our code of binary evolution to describe the observed state transitions.

  5. Hacia una adaptación cultural para el tratamiento de trastornos alimentarios en latinos en Estados Unidos.

    PubMed

    Reyes-Rodríguez, Mae Lynn; Bulik, Cynthia M

    2010-01-01

    Eating disorders affect all ethnic and socioeconomic groups. However, evidence based treatments for eating disorders have been developed and tested exclusively on Caucasian populations. With the purpose to develop a culturally sensitive framework for the eating disorders treatment in Latinos/as, the objectives of this work were: 1) identify and describe some of the relevant cultural elements for eating disorders in the Latino population and, 2) to draft a culturally sensitive intervention model for eating disorders in Latino population in the United States. Providing culturally sensitive treatments for Latinos with psychiatric disorders is essential to reverse public health disparities.

  6. Geoquímica orgánica de los carbones de fila maestra, estado anzoátegui, Venezuela

    NASA Astrophysics Data System (ADS)

    Moreno, O.; Martinezy, M.; Escobar, M.

    1995-04-01

    The vertical and lateral variability of organic geochemical parameters was established for the Seam 4 of the Fila Maestra coal deposit (Quebradon Formation, Oligocene-Early Miocene age) through the study of coals and carbonaceous shales collected in different outcrops of the coal seam. Chemical and physical analysis included moisture and ash contents, maceral groups, vitrinite reflectance, total carbon, bitumen and its fractions, as well as characterization of saturated hydrocarbons by gas chromatography ( n-alkane distributions and {pristane}/{phytane} ratios). A production sample, representative of the Seam 4, was further analyzed for S, Cl, C, H, O and its calorific value determined. The data collected allowed us to classify these samples as high-volatile bituminous coals, types B and C, according to ASTM classification. The results of the analysis showed little vertical or lateral variation in the properties studied. A gradual increase in ash content in the westward direction, together with a thinning of the coal seam, suggest a greater proximity of the basin border in this direction. High values in {pristane}/{phytane} ratio (4-7), predominance of heavy alkanes and high contents in vitrinites clearly indicates that primigenic organic matter was essentially continental in character. However, the bimodal n-alkane distribution, together with a nigh sulfur (2.7%) and chlorine (0.12%) contents suggest a marine-influenced environment. In consequence, it is proposed that these coals were formed in a transitional environment, as salt-marshs in coastal lagoons or in low deltaic plains. These results are in agreement with the stratigraphic analysis of the sedimentary unit.

  7. Translation and cultural adaptation of the Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia (FACIT-CD) to evaluate quality of life in women with cervical intraepithelial neoplasia.

    PubMed

    Fregnani, Cristiane Menezes Sirna; Fregnani, José Humberto Tavares Guerreiro; Paiva, Carlos Eduardo; Barroso, Eliane Marçon; Camargos, Mayara Goulart de; Tsunoda, Audrey Tieko; Longatto-Filho, Adhemar; Paiva, Bianca Sakamoto Ribeiro

    2017-01-01

    , um de Portugal e um dos Estados Unidos. Ao término do processo de tradução e retrotradução, deu-se início ao processo de análise semântica. Foram incluídas aleatoriamente 20 mulheres entre 18 e 70 anos com exame de citologia cervical alterado, atendidas no Departamento de Prevenção e Ginecologia Oncológica do Hospital de Câncer de Barretos. A amostra foi composta por mulheres com baixa escolaridade. No primeiro pré-teste participaram dez mulheres, sendo que a metade considerou as questões CD1, CD2 e CD3 difíceis por não compreenderem o significado do termo "região pélvica". A questão CD5, "Estou preocupada em disseminar a infecção", também foi considerada de difícil entendimento por cinco mulheres. Após as reconsiderações do comitê de especialistas e do grupo FACIT, foi realizado o segundo pré-teste. Nesta fase, pode-se concluir que os problemas de entendimento anteriores foram resolvidos. A versão traduzida do FACIT-CD é equivalente à versão original em inglês e em língua portuguesa universal, sendo facilmente compreendida pelas pacientes com neoplasia intraepitelial cervical.

  8. Genetic relationships of the Portuguese Lidia bovine populations

    PubMed Central

    Correia, P; Baron, E; da Silva, J. M; Cortés, O

    2014-01-01

    To clarify the genetic relationships among the Lidia breed lineages and two main Portuguese Lidia bovine populations, Casta Portuguesa and Brava dos Açores, 24 autosomal microsatellites were analyzed in 120 samples. Brava dos Açores showed the highest observed and expected heterozygosity (0.73 and 0.70, respectively) while Casta Portuguesa showed the lowest observed and expected heterozygosity (0.51 and 0.50, respectively). The results of this study were compared with the previous microsatellites data from the main Lidia bovine lineages. Casta Portuguesa was the most genetically isolated Lidia bovine population as revealed by the average FST genetic distance value with respect to the other lineages (32%). All the populations of Portuguese Lidia had negative FIS values. The Neighbour-joining dendrogram grouped Casta Portuguesa in the same branch with Miura, which was supported by the STRUCTURE software. The results evidenced low levels of genetic diversity and high levels of genetic differentiation in Casta Portuguesa and high levels of genetic diversity in Brava dos Açores populations, probably due to the crossbreeding of different bovine lineages at origin, and genetic flow among herds. PMID:27175132

  9. Aging Mechanisms and Control. Symposium Part A - Developments in Computational Aero- and Hydro-Acoustics. Symposium Part B - Monitoring and Management of Gas Turbine Fleets for Extended Life and Reduced Costs (Les mecanismes vieillissants et le controle) (Symposium Partie A - Developpements dans le domaine de l’aeroacoustique et I’hydroacoustique numeriques) (Symposium Partie B - Le suivi et la gestion des turbomoteurs en vue du prolongement de l

    DTIC Science & Technology

    2003-02-01

    forensic aspects. Aviation, Space & Environmental Medicine 1999; 70 (3, Suppl): A145-51. 5. Canas J, Martinho Pimenta AJF, Castelo Branco NAA, ERP...E, Castelo Branco NAA. Performance assurance computerized test – PACT. Revista Portuguesa de Medicina Militar 1993; 41 (1-4): 21-27. 16. Rodriguez E...Portuguesa de Medicina Militar 1992: 40(1-4): 41-45. 17. GIMOGMA. Epilepsia sintomática de etiologia vascular, manifestação da síndrome das vibrações

  10. Students of dietetics & nutrition; a high risk group for eating disorders?

    PubMed

    Mealha, Vanessa; Ferreira, Catarina; Guerra, Inês; Ravasco, Paula

    2013-01-01

    Introducción: Los cambios en la conducta alimentaria de los estudiantes universitarios son comunes y se han estudiado ampliamente. Aunque el riesgo de desarrollo de trastornos de la alimentación parece ser obvio entre los estudiantes de nutrición, hay una falta de investigación en este campo. Este estudio se propuso: determinar el riesgo de desarrollar trastornos de la alimentación en los estudiantes de Dietética y Nutrición mediante la comparación entre las conductas alimentarias, los hábitos dietéticos, el estado nutricional, la composición corporal y la actividad física con respecto a la de otros estudiantes (de grados de la salud y no relacionados con la salud). Métodos: Estudio comparativo transversal. La muestra comprendía 189 estudiantes mujeres, con edades entre 18 y 25 años (20,3 ± 2,0) de dos universidades públicas portuguesas. En todas las estudiantes se midió el peso, la talla, el porcentaje de masa grasa y la circunferencia de la cintura, y todas ellas contestaron cuatro cuestionarios validados que evaluaban la conducta alimentaria, los patrones de alimentación y la actividad física. Resultados: Hubo un riesgo bajo de desarrollar trastornos de la alimentación en estas estudiantes (4,2%). No hubo diferencias significativas entre las estudiantes de DN, salud y otras disciplinas no relacionadas con la salud con respecto a la conducta alimentaria, el estado nutricional o la composición corporal, lo que contrastaba con diferencias en algunos hábitos dietéticos y la actividad física (p < 0,05). Conclusiones: A pesar del riesgo bajo de trastornos de la alimentación entre las estudiantes de DN, un gran porcentaje de ellas tenía preocupación por el peso corporal. Las estudiantes de DN tenían los mayores porcentajes de peso normal, ausencia de riesgo cardiometabólico de acuerdo a la circunferencia de la cintura y la masa grasa normal. Estas estudiantes tenían los hábitos dietéticos más saludables y también practicaban una

  11. A Transferencia do Controle da Educacao da Igreja para o Estado (The Transfer of Educational Control from the Church to the State).

    ERIC Educational Resources Information Center

    Silva, Marcos

    2000-01-01

    Analyzes the principal phases in the historical process of the occidental world that resulted in the transfer of educational control from the church to the state, demonstrating some of the consequences of this historic turn. (BT)

  12. Estados unidos puede tomar la delantera en la educacion: 50 consejos utiles (The United States Can Take the Lead in Education: 50 Suggestions).

    ERIC Educational Resources Information Center

    Education Excellence Partnership, Washington, DC.

    The Spanish-language booklet lists ways that parents, employers, teachers, administrators, principals, and grandparents, neighbors, and concerned citizens can help America reach the National Educational Goals. First, the booklet summarizes the National Education Goals in the areas of school readiness; school completion; student achievement and…

  13. Modelo Crosscultural de Pasantias para Lideres de la Educacion: Cooperacion entre Estados Unidos y Venezuela (Designing an Effective School Administrator Internship Program: United States and Venezuela Cooperation).

    ERIC Educational Resources Information Center

    Serafin, Ana Gil; Thompson, Eugene W.

    A model was developed of an internship program designed to give valuable cross-cultural experience to school administrators in training at universities in the United States and Venezuela. A naturalistic approach was used to develop the model. Leading school administrators and educational leadership theorists in both countries were interviewed by…

  14. Utilização Do Sensor Airdas (Airborne Infrared Disaster Assessment System) no monitoramento de desflorestamentos no norte do estado do mato grosso - Brasil

    Treesearch

    Geraldo José Lucatelli Dória de Araújo; João Antônio Raposo Pereira; Tânia Maria Vieira da Silva; Helvécio Mafra; James A. Brass; Robert N. Lockwood; Robert G. Higgins; Philip J. Riggan

    2008-01-01

    This study has as objective to assess AIRDAS (Airborne Infrared Disaster Assessment System) sensor for the monitoring of deforestation in the northern area of Mato Grosso State, between the latitudes 10° and 12° south and longitudes 54° and 56° west, within the area known as deforestation arch. The results show that the main advantage of...

  15. [Presence of fecal coliforms, Escherichia coli and DNAse- and coagulase-positive Staphylococcus aureus, in "colonial" cheese sold in the city of Blumenau, Estado de Santa Catarina, Brazil].

    PubMed

    Reibnitz, M G; Tavares, L B; García, J A

    1998-01-01

    Twenty cheese samples were collected at Blumenau (SC) and were submitted to analysis in order to verify the presence of fecal coliforms, Escherichia coli and Staphylococcus aureus. Among the 20 samples of cheese, analysis revealed that 70% and 20% respectively, were not within present legal specifications (Norma 001/87-DNVSA) for fecal coliforms and Escherichia coli. For Staphylococcus, 95% of the samples were not within present legal specifications.

  16. [Nutritional and metabolic factors as risk factors for cardiovascular diseases in an adult population in the city of Maracibo, Estado Zulia, Venezuela].

    PubMed

    García-Araujo, M; Semprún-Fereira, M; Sulbarán, T A; Silva, E; Calmón, G; Campos, G

    2001-03-01

    To analyze the nutritional and metabolic risk factors for Cardiovascular Diseases (CVD) present in a group of people in the city of Maracaibo a study was performed with 209 volunteers (145 women and 64 men) between 20 and 89 years of age who underwent: a) Anthropometric Evaluation: Body Mass Index (BMI) and Waist-to-Hip Ratio (WHR) and Physical Examination: Systolic (SBP) and Diastolic Blood Pressure (DBP); b) Dietetic Evaluation (24 hours recall), and c) Biochemical Evaluation: Glycemia (GLYC), Triglycerides (TG), Total Cholesterol (CHOL), HDL-C, LDL-C and VLDL-C, applying enzymatic methods. It was also investigated, their Age, Family History of Metabolic Alterations (FHMA), physical activity, smoking habits and alcohol consumption. More than 50% of the individuals showed a BMI > 25; 64% of women showed a WHR value > 0.8; 34 and 28% of men and women respectively had a high fat ingestion (HFI); 36% of men had hypertriglyceridemia and high levels of VLDL-C; 41% of women and 30% of men showed decreased HDL-C. A high frequency of FHMA was found in 85% of women and 78% of men followed by sedentary life in 64% of men and 79% of women. The age significantly (p < 0.05) affected the values for WHR, SBP, DBP, GLYC, CHOL, TG, HDL-C, LDL-C and VLDL-C. The dietetic evaluation showed a diet that was low in calories, high in protein, normal in fat and low in carbohydrates. It is concluded that the population elected for this study might be considered under a high risk for CVD, since both nutritional and metabolic factors, as well as the other risk factors analyzed, were present in a high percentage of the individuals studied.

  17. A Transferencia do Controle da Educacao da Igreja para o Estado (The Transfer of Educational Control from the Church to the State).

    ERIC Educational Resources Information Center

    Silva, Marcos

    2000-01-01

    Analyzes the principal phases in the historical process of the occidental world that resulted in the transfer of educational control from the church to the state, demonstrating some of the consequences of this historic turn. (BT)

  18. [Group psychotherapy. Experience with a changing process at a clinic of the Instituto del Servicio de Seguridad Social de los Trabajadores del Estado (ISSSTE)].

    PubMed

    Velasco de Ongay, M E

    1977-01-01

    The problems of an ISSSTE clinic were approached within the general systems theory and it was observed that within the group there existed forces to maintain the status-quo and forces towards change; to produce the latter the group was handled during 20 hours with a slightly directive technique. The goals were to improve interpersonal relationships, to increase communication, to make known to individuals their attitudes within a group and make them sensitive to problems they shared with others. The results were good, the status-quo was broken and change started occurring.

  19. Queridos Padres: En Los Estados Unidos...La Escuela es Nuestra Tambien (Dear Parents: In the United States...It's Our School Too).

    ERIC Educational Resources Information Center

    Nicolau, Siobhan; Ramos, Carmen Lydia

    This guidebook for Hispanic parents advises that children's success in school may depend on the home environment during the formative years. Hispanic youth drop out of school at a rate of 40 percent; 25 percent of those who graduate are not qualified for good jobs. In Latin American countries, parents are expected to leave education to the…

  20. The Assessment of the Intelligence of Latinos in the United States. (La Medicion de la Inteligencia de los Latinos en los Estados Unidos).

    ERIC Educational Resources Information Center

    Cauce, Ana M.; And Others

    Most of the research on the assessment of the intelligence of Latinos in the United States appears to be based on some possibly erroneous or at least dubious assumptions. Among these are the following: (1) the assumption of bilinguality; (2) the assumption of equal proficiency in the English language; (3) the assumption of the equivalence of…

  1. The Assessment of the Intelligence of Latinos in the United States. (La Medicion de la Inteligencia de los Latinos en los Estados Unidos).

    ERIC Educational Resources Information Center

    Cauce, Ana M.; And Others

    Most of the research on the assessment of the intelligence of Latinos in the United States appears to be based on some possibly erroneous or at least dubious assumptions. Among these are the following: (1) the assumption of bilinguality; (2) the assumption of equal proficiency in the English language; (3) the assumption of the equivalence of…

  2. El Mantenimiento o Desplazamiento Linguistico: El Futuro del Espanol en los Estados Unidos. (Linguistic Maintenance or Replacement: The Future of Spanish in the United States)

    ERIC Educational Resources Information Center

    Gaarder, Bruce A.

    1976-01-01

    What is the probability that Spanish, as a vernacular language, will survive in the U.S. with an increasing usage and prestige? Or will its usage, its speakers and its importance diminish rapidly in number and geographical extension? Can it be retained or will there be a shift into English? This article, written in Spanish, addresses these…

  3. Parent's Guide to Special Education in Washington State, 1985-86 [and] Guia para Padres: Para Educacion Especial en el Estado de Washington.

    ERIC Educational Resources Information Center

    Washington Office of the State Superintendent of Public Instruction, Olympia.

    This pamphlet guides parents of children with disabilities through the procedures for acquiring special education services in the state of Washington. Following an overview of special education, the pamphlet presents information on notice and consent procedures, confidentiality of records, individualized education programs (IEP), the placement…

  4. El Mantenimiento o Desplazamiento Linguistico: El Futuro del Espanol en los Estados Unidos. (Linguistic Maintenance or Replacement: The Future of Spanish in the United States)

    ERIC Educational Resources Information Center

    Gaarder, Bruce A.

    1976-01-01

    What is the probability that Spanish, as a vernacular language, will survive in the U.S. with an increasing usage and prestige? Or will its usage, its speakers and its importance diminish rapidly in number and geographical extension? Can it be retained or will there be a shift into English? This article, written in Spanish, addresses these…

  5. Parent's Guide to Special Education in Washington State, 1985-86 [and] Guia para Padres: Para Educacion Especial en el Estado de Washington.

    ERIC Educational Resources Information Center

    Washington Office of the State Superintendent of Public Instruction, Olympia.

    This pamphlet guides parents of children with disabilities through the procedures for acquiring special education services in the state of Washington. Following an overview of special education, the pamphlet presents information on notice and consent procedures, confidentiality of records, individualized education programs (IEP), the placement…

  6. [Occupational accidents in Municipio Maracaibo, Estado Zulia, Venezuela, 1979-1990. Determination of the frequency and risk factors which play a role in their production].

    PubMed

    Fernández-D'Pool, J; Montero-Proaño, G

    1993-01-01

    During the period of 1979-1990 job-related injuries were studied in Maracaibo, Zulia state, in order to analyze frequencies and causes. This information was obtained from annual reports on job-related injuries Form Number 15-411 of the Venezuelan Institute of Social Security (IVSS) which has been implemented nationally since 1982. Accidents that caused loss of man-hours were considered; variables considered were: age, risk category, day of the week, work shift, month, type of accident, agent, type of lesion, mechanical cause, body part affected and type of the activity in which the company is involved. The results were expressed as absolute values (mean +/- SE) and relative values. The mean accidents/year was 1651 +/- 177.97, most of them occurring in the age groups of 20-29 years (368.8) and 30-39 years (359.8). The triannual mean rate was higher for the group of the non-serious accidents (50%). Tuesday was the day of higher accidental incidence (22%) in addition to the morning shift between 9 and 11 hours (55%). Manufacturing was the economic activity most affected (43%). The most common causative agents were materials, substances and radiations (35%). The use of defective tools were the most frequent causes of mechanical accidents (31%). Upper limbs (46%) and between the type of lesion contusions or/and bruises (53%). It was concluded that, although the number of workers and accidents slowly diminished, the accidents rate slightly increased.

  7. Feedback Cheerleader, Mean-Spirited Feedback Estudio Critico Discursivo De Ideologias Sobre El Feedback Escrito En Un Departamento Universitario De Espanol En Estados Unidos

    ERIC Educational Resources Information Center

    Dominguez-Mujica, Maria Eugenia

    2012-01-01

    The aim of this research is to investigate ideologies that monitor and control styles of written feedback as well as discursive resources used in the expression of those ideologies. Using socio-cognitive analysis, a development of critical discourse studies, I have analyzed 44 sessions of chat on the Internet, 78 journal notes, 31 emails and 12…

  8. Feedback Cheerleader, Mean-Spirited Feedback Estudio Critico Discursivo De Ideologias Sobre El Feedback Escrito En Un Departamento Universitario De Espanol En Estados Unidos

    ERIC Educational Resources Information Center

    Dominguez-Mujica, Maria Eugenia

    2012-01-01

    The aim of this research is to investigate ideologies that monitor and control styles of written feedback as well as discursive resources used in the expression of those ideologies. Using socio-cognitive analysis, a development of critical discourse studies, I have analyzed 44 sessions of chat on the Internet, 78 journal notes, 31 emails and 12…

  9. Financiamiento público y privado para la investigación forestal en el sur de Estados Unidos durante el período 1920-2000

    Treesearch

    John A. Stanturf; Robert Kellison; F.S. Broerman; Stephen Jones; Alan Lucier

    2002-01-01

    Public and Private Funding of Forestry Research in the Southern United States, 1929-2999. Forest management in the southern United States intensified over the last 80 years and the pine forests of the Coastal Plain can be regarded as in the early stage of crop domestication. In 1997, 57 % of the softwood and 52 % of the hardwood timber produced in the country came from...

  10. Latino Families in the United States. A Resourcebook for Family Life Education = Las Familias Latinas en los Estados Unidos. Recursos para la Capacitacion Familiar.

    ERIC Educational Resources Information Center

    Andrade, Sally J., Ed.

    The primary objectives of this resource book are to increase family life educators' knowledge and understanding of Latinos and to encourage advocacy by Latinos for appropriate family life programs in their communities. English and Spanish versions of the same text are included. There are six chapters. Chapter 1 outlines the book's objectives and…

  11. Diagnostic flexible bronchoscopy and accessory techniques.

    PubMed

    Dionísio, J

    2012-01-01

    We reviewed the most important diagnostic procedures implemented by means of flexible bronchoscopy, including bronchoalveolar lavage, bronchial brushing and biopsy, transbronchial lung biopsy and transbronchial needle aspiration. We reviewed the tools, techniques and potential complications of this examination. Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  12. Non-small cell lung cancer patients treated with erlotinib - Clinical cases.

    PubMed

    Dionísio, Jorge; Almodôvar, Teresa; Matias, Dina; Ferreira, Paula; Mota, Paulo; da Costa, J Duro

    2008-10-01

    We present four patients with non-small cell lung cancer treated in second and third line with Erlotinib. These are selected patients that obtained a good clinical response. Almost all presented cutaneous side effects. Rev Port Pneumol 2008; XIV (Supl 3): S65-S69. © 2008 Sociedade Portuguesa de Pneumologia/SPP.

  13. The Use of In-Service Inspection Data in the Performance Measurement of Non-Destructive Inspections (Mise en oeuvre de donn es resultant de visites d’inspection en service pour l’evaluation des performances des visites d’inspection non destructives)

    DTIC Science & Technology

    2005-03-01

    Administrativo Direccao de Mecanica Aeronautica/GZE avenue dea Forca Aerea Portuguesa email: jnogueira@emfa.pt UNITED KINGDOM Dr. D. Bruce DSTL...variance of the response variable. The same criterion applies here, where the POD-scale parameter serves in the role of the response variable error

  14. Management and Operation of Armed Forces Radio and Television Service (AFRTS)

    DTIC Science & Technology

    1988-02-01

    deviant or socially unacceptable behavior; material promoting religious cults; material promoting the overthrow of governments, etc. CHAPTER 5 Internal...personal data (e.g., social security number, home address, etc.) in accordance with pertinent Service regulations. Storage media and printed materials...Muziek Autersrecht (BUMA) Norway Norsk Komponistforenings Internasjonale Musikkbyra (TONO) 14-1 Portugal Sociedad Portuguesa de Autores (SPA) Spain

  15. Personality and Learning Styles Surrounded by W3 Software: The Macao Portuguese School Case

    ERIC Educational Resources Information Center

    Negreiros, João; Baptista, Zelia; Lee, Leanda

    2014-01-01

    One of the purposes of this study is to evaluate how the choice of teaching method can be assisted by knowledge of a student's personality type and learning style. The present research is undertaken in the context of Web 2.0 tools use within the Portuguese literature subject at Escola Portuguesa de Macao (EPM). The Felder-Soloman index of learning…

  16. Cardiac resynchronization therapy: Femoral approach.

    PubMed

    Brandão, Luís; Miranda, Rita; Almeida, Sofia; Ribeiro, Luciano; Alvarenga, Carlos; João, Isabel; Pereira, Hélder

    2017-04-01

    We describe the case of a 62-year-old female patient with bilateral subclavian vein occlusion, in whom a cardiac resynchronization system was implanted via a femoral vein. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Combined venoarterial extracorporeal membrane oxygenation and transcatheter aortic valve implantation for the treatment of acute aortic prosthesis dysfunction in a high-risk patient.

    PubMed

    Pergolini, Amedeo; Zampi, Giordano; Tinti, Maria Denitza; Polizzi, Vincenzo; Pino, Paolo Giuseppe; Pontillo, Daniele; Musumeci, Francesco; Luzi, Giampaolo

    2016-01-01

    We describe the case of a patient with acute bioprosthesis dysfunction in cardiogenic shock, in whom hemodynamic support was provided by venoarterial extracorporeal membrane oxygenation, and successfully treated by transcatheter aortic valve implantation. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Personality and Learning Styles Surrounded by W3 Software: The Macao Portuguese School Case

    ERIC Educational Resources Information Center

    Negreiros, João; Baptista, Zelia; Lee, Leanda

    2014-01-01

    One of the purposes of this study is to evaluate how the choice of teaching method can be assisted by knowledge of a student's personality type and learning style. The present research is undertaken in the context of Web 2.0 tools use within the Portuguese literature subject at Escola Portuguesa de Macao (EPM). The Felder-Soloman index of learning…

  19. Space Wei QI: The Launch of Shenzhou V

    DTIC Science & Technology

    2004-01-01

    as well as in economic construction, national security, science & technology development and social progress. The devel- opment of space activities...Portuguesa para o Desen- volvimento da Comunicações, www.apdc.pt/ actividades/ eventos /conferencia/rtf/ Menin.pdf. 49. “From A-bomb to Shenzhou V,” Xinhua

  20. Off-Label and Unlicensed Drug Use in Neonatology: Reality in a Portuguese University Hospital.

    PubMed

    Silva, Joana; Flor-de-Lima, Filipa; Soares, Henrique; Guimarães, Hercília

    2015-01-01

    Introdução: Este estudo pretende caracterizar os medicamentos usados numa Unidade de Cuidados Intensivos Neonatais portuguesa, avaliar a frequência do uso de fármacos off-label ou não licenciados de acordo com a informação disponível no Resumo das Caraterísticas do Medicamento e comparar resultados entre recém-nascidos prematuros e de termo.Material e Métodos: Um estudo retrospetivo transversal foi conduzido na nossa Unidade de Cuidados Intensivos Neonatais no primeiro semestre de 2013. Os dados das prescrições realizadas foram comparados com a informação pediátrica contida nos Resumos das Caraterísticas do Medicamento.Resultados: Analisámos 1011 prescrições respeitantes a 84 substâncias ativas, feitas em 218 admissões. Em 42,9% dos casos, os fármacos foram usados de acordo com a informação do Resumo das Caraterísticas do Medicamento; 27,9% dos fármacos eram aprovados para o período neonatal mas usados de forma off-label; medicamentos off-label para a idade neonatal foram usados em 10,1%, enquanto aqueles com estado de aprovação indeterminado ou contraindicados foram usados em 6,0% e 8,7% dos casos, respetivamente. As prescrições não licenciadas representaram 4,4% do total. Os recém-nascidos pré-termo receberam uma taxa superiorde fármacos usados de acordo com o Resumo das Caraterísticas do Medicamento (p < 0,0001), enquanto os de termo receberam mais fármacos off-label para dose/frequência (p < 0,0001) e contraindicados para recém-nascidos (p < 0,012).Discussão: Os prematuros receberam um número mediano de fármacos superior, o que se relaciona com o seu internamento mais prolongado. A principal razão para prescrições off-label foi a utilização de doses/frequências de administração diferentes das referidas no Resumo das Caraterísticas do Medicamento, reforçando a necessidade de atualização destes documentos. A manipulação dosmedicamentos é uma das causas para o seu uso não licenciado, enfatizando a falta de

  1. Erlotinib: A successful clinical case and some notes about hepatic toxicity.

    PubMed

    Costa, Agostinho

    2008-10-01

    A case of a woman with lung adenocarcinoma in which fifteen-month disease control was achieved with second-line erlotinib treatment is presented. Five months after treatment beginning, isolated grade 3 hyperbilirubinemia occurred and daily dose was reduced to 100mg. Comments on erlotinib hepatic toxicity and the pharmacologic interactions on erlotinib metabolism are given. Rev Port Pneumol 2008; XIV (Supl 3): S29-S34. © 2008 Sociedade Portuguesa de Pneumologia/SPP.

  2. Portuguese Armed Forces in the International Security and Assistance Force in Afghanistan: Psychological Support for the Command of Kabul International Airport

    DTIC Science & Technology

    2006-04-01

    Paz: - O modelo de avaliação psicológica: Considerações epistemológicas e metodológicas. Revista de Psicologia Militar. Nº 11, pp. 173-184. Silva, D...População Militar Portuguesa. Revista de Psicologia Militar, Nº 12 – 1999/2000. Surrador, A. (2003). Contribuição da Psicologia Militar para as

  3. 11th National Meeting of Organic Chemistry and 4th Meeting of Therapeutic Chemistry

    PubMed Central

    Sousa, Maria Emília; Araújo, Maria João; do Vale, Maria Luísa; Andrade, Paula B.; Branco, Paula; Gomes, Paula; Moreira, Rui; Pinho e Melo, Teresa M.V.D.; Freitas, Victor

    2016-01-01

    For the first time under the auspices of Sociedade Portuguesa de Química, the competences of two important fields of Chemistry are brought together into a single event, the 11st National Organic Chemistry Meeting and the the 4th National Medicinal Chemistry Meeting, to highlight complementarities and to promote new synergies. Abstracts of plenary lectures, oral communications, and posters presented during the meeting are collected in this report. PMID:27102166

  4. Cardiac involvement in antiphospholipid syndrome associated with Sneddon syndrome: a challenging diagnosis.

    PubMed

    Faustino, Ana; Paiva, Luís; Morgadinho, Ana; Trigo, Emília; Botelho, Ana; Costa, Marco; Leitão-Marques, António

    2014-02-01

    Sneddon syndrome is a rare clinical entity characterized by the association of ischemic cerebrovascular disease and livedo reticularis. The authors report a case of stroke and myocardial infarction in a 39-year-old man with Sneddon syndrome and antiphospholipid syndrome who subsequently met some criteria for systemic lupus erythematosus, highlighting the complexity of cardiovascular involvement in systemic diseases. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  5. Steroid-induced recurrent myocardial ischemia.

    PubMed

    Yildirim, Ufuk; Gulel, Okan; Soylu, Korhan; Yuksel, Serkan; Sahin, Mahmut

    2014-01-01

    We report the case of a female patient under oral prednisolone therapy due to a diagnosis of idiopathic intracranial hypertension with papilledema. Unfortunately, short-term treatment with prednisolone caused an unusual complication in the patient, i.e., recurrent myocardial ischemia. Possible mechanisms leading to this complication were evaluated in the light of current knowledge. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  6. 'Jamaican Stone': A potentially lethal remedy for delaying ejaculation.

    PubMed

    Díaz-Antón, Belén; Alonso-Deniz, Guillermo; Perez-Vela, Jose Luis; Molina-Martín de Nicolás, Javier; Rubio-Alonso, Belen; Jurado-Román, Alfonso; Miguel-Gutierrez, Ana; Martin-Asenjo, Roberto

    2017-02-01

    Poisoning by ingestion of 'Jamaican Stone', a kind of cardioactive steroid, is extremely rare. However, mortality is very high. For this reason, when it occurs, an early and accurate diagnosis represents a critical challenge for clinicians. We present an unusual case of electrical storm caused by this substance. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. [Isolated left ventricular noncompaction causing refractory heart failure].

    PubMed

    Meneguz-Moreno, Rafael Alexandre; Rodrigues da Costa Teixeira, Felipe; Rossi Neto, João Manoel; Finger, Marco Aurélio; Casadei, Carolina; Castillo, Maria Teresa; Sanchez de Almeida, Antonio Flávio

    2016-03-01

    Left ventricular noncompaction is a rare congenital anomaly characterized by excessive left ventricular trabeculation, deep intertrabecular recesses and a thin compacted layer due to the arrest of compaction of myocardial fibers during embryonic development. We report the case of a young patient with isolated left ventricular noncompaction, leading to refractory heart failure that required extracorporeal membrane oxygenation followed by emergency heart transplantation. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. New less invasive ventricular reconstruction technique in the treatment of ischemic heart failure.

    PubMed

    Faria, Rita; Melica, Bruno; Pires-Morais, Gustavo; Rodrigues, Alberto; Ribeiro, José; Guerra, Miguel; Gama, Vasco; Vouga, Luís

    2014-01-01

    Ischemic cardiomyopathy is the leading cause of heart failure. In patients with left ventricular (LV) dilatation, low ejection fraction, and transmural scar in an anteroseptal distribution, surgical ventricular reconstruction (SVR) is a treatment option. We describe our first experience with the Less Invasive Ventricular Enhancement (LIVE) technique using the Revivent™ system (Bioventrix Inc., San Ramon, CA), in the treatment of a large anteroapical aneurysm. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. A Numerical Study of Time-Dependent Wind Forcing Off the West Coast of Portugal, 1987 - 1988

    DTIC Science & Technology

    1991-06-01

    Navy. In fact, naval research planning and programming guidance from the Chief of Naval Research has targeted coastal processes because they "...impact...correntes, temperaturas e salinidades na vertente continental Portuguesa a 40 N. Relatorio tecnico , 1185, Grupo de Oceanografia, Universidade de Lisboa...upwelling. Prog. Oceanog. 2, 223-257. 102 Chief of Naval Research, Office of Naval Research, 1987: Fy-91/95 Naval research planning and programming guidance

  10. A rare case of persistent troponin elevation in a patient with chronic heart failure.

    PubMed

    Cardoso, Gonçalo; Aguiar, Carlos; Ventosa, António; Rebocho, Maria José; Borges Santos, Miguel; Dores, Hélder; Adragão, Pedro; Mendes, Miguel

    2013-11-01

    We present the case of a woman diagnosed with hypertrophic cardiomyopathy who suffered a myocardial infarction when she was 28 years old, without coronary artery disease on coronary angiography. Two years later, she presented signs of heart failure and left ventricular systolic dysfunction with persistent troponin I elevation, followed by progressive worsening of ventricular dysfunction. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. Hypertrophic cardiomyopathy associated with left ventricular noncompaction cardiomyopathy and coronary fistulae: a case report. One genotype, three phenotypes?

    PubMed

    Delgado, Anne; Moreira, Davide; Rodrigues, Bruno; Correia, Emanuel; Gama, Pedro; Cabral, Costa; Marinho, António; Santos, Oliveira

    2013-11-01

    The authors present a rare case of hypertrophic cardiomyopathy associated with left ventricular noncompaction cardiomyopathy and coronary artery-left ventricular fistulae in a 42-year-old woman presenting with non-ST-elevation myocardial infarction. Coronary angiography, transthoracic echocardiography and cardiac magnetic resonance revealed the structural abnormalities of the left ventricle and the coronary tree. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. [Atrioventricular septal defect in an adult patient: There are 'clefts' and clefts].

    PubMed

    Moreno, Nuno; Almeida, Jorge; Amorim, Mário Jorge

    2016-03-01

    In this report, we present the case of an adult male with severe mitral regurgitation due to an atrioventricular septal defect. Anatomical assessment by two- and three-dimensional transesophageal echocardiography was essential for detailed morphological characterization and surgical planning. The different features of a 'cleft' in an atrioventricular septal defect compared to an anterior leaflet cleft in an otherwise normal mitral valve are here discussed. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Loculated cardiac hematoma causing hemodynamic compromise after cardiac surgery.

    PubMed

    Fernandes, Andreia; Cassandra, Miryan; Pinto, Carlos; Oliveira, Catarina; Antunes, Manuel; Gonçalves, Lino

    2015-09-01

    The authors describe a case of a rare complication occurring after cardiac surgery. Three weeks after aortic valve replacement a young male became hemodynamically unstable. The echocardiogram showed a large loculated hematoma compressing the right atrium. The patient was reoperated and the mass was removed. Recovery was complete. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  14. 11(th) National Meeting of Organic Chemistry and 4(th) Meeting of Therapeutic Chemistry.

    PubMed

    Sousa, Maria Emília; Araújo, Maria João; do Vale, Maria Luísa; Andrade, Paula B; Branco, Paula; Gomes, Paula; Moreira, Rui; Pinho E Melo, Teresa M V D; Freitas, Victor

    2016-03-17

    For the first time under the auspices of Sociedade Portuguesa de Química, the competences of two important fields of Chemistry are brought together into a single event, the 11st National Organic Chemistry Meeting and the the 4th National Medicinal Chemistry Meeting, to highlight complementarities and to promote new synergies. Abstracts of plenary lectures, oral communications, and posters presented during the meeting are collected in this report.

  15. [Necessities of professionals of the family health teams from the "4a Coordenadoria Regional de Saúde do Estado do Rio Grande do Sul" for training and improvement].

    PubMed

    Ferreira, Maria Evanir Vicente; Schimith, Maria Denise; Cáceres, Nilton Carlos

    2010-08-01

    This study had the aim to verify the necessities of training and improvement of the 4th Regional Coordination in Health of Rio Grande do Sul State family health teams. The data collection was carried out through the application of questionnaires with objective questions, composed by two parts: field and competence nucleus. For data analyses, Normality, Chi-Square and G tests were used as statistical procedures for Easy and Difficult attributions indicated by the professionals. Professionals have shown less difficulty with generic attributions, related with basic methods and techniques of each health area. However, they have revealed a lot of difficulties with attributions relating to the search of new partners in health inside communities, stimulation of the people participation in the discussion of health rights, and completion of the SIA/SIAB forms, and others. Even after 12 years of the foundation of the Family Health Program (PSF), several difficulties are still observed concerning the way to work with this new health strategy in Brazil. Proposals are made for the complete understanding and improvement of the PSF strategy.

  16. Dermatitis causada por Hylesia metabus (Lepidoptera: Hemileucidae) en la región costera del Estado del Delta del Amacuro, Venezuela [Dermatitis caused by Hylesia metabus (Lepidoptera: Hemileucidae) in the costal region of the state of Delta Amacuro, Venezuela].

    PubMed

    Rodríguez-Acosta, A; Rubiano, H; Reyes, M; Fernández, C T

    1998-01-01

    2 cases of acute dermatitis caused by butterfly Hylesia metabus in an area that so far has not been considered as endemic for this species were presented. The dermatitis observed in these individuals may be described as very circumscribed, pruriginous, erythematous generalized protruding papules that may be compared with urticaria, and with a variable degree oedema. Monomorphic eruption consisting in small hard papules crowned by a little vesicle was also present. The lesions of these 2 patients evolved with intensely pruriginous papules for a week and after that they healed without dermatological sequelae.

  17. A preliminary combined geochemical and rock-magnetic study of tailings of non-magnetic ores from Tlalpujahua-El Oro mining districts, Michoacán and Estado de México States

    NASA Astrophysics Data System (ADS)

    Morales, J.; Hernández-Bernal, M.; Corona-Chávez, P.

    2013-05-01

    Mining activities in Mexico have been continuously developed since 1550. Since then several thousands of million tons of waste produced as a result of the mining activity have been accumulated and scattered throughout the territory. These wastes can contain minerals with potentially toxic elements (PTEs) such as Cr, As, Cd, Cu, Pb, Zn, which show a distribution and mobility in the environment according to the chemical species in which are hosted. The Tlalpujahua - El Oro mining district (TOMD) concentrates an impressive number of mines and historical tailings. Due to their in-slope hydrographic position, the mining activities increase the risk of generating anthropogenic effluent that could contribute with a certain amount of mine-water with high contents of PTEs. Although magnetic methods have been widely applied to pollution studies of regions with high anthropogenic impact, its application to tailings is scarce in spite of the several studies that document the environmental effects as a result of the mining waste. We present the results obtained by combined geochemical and rock-magnetic studies in these tailings. Similarly to the traditional EPTs vs SiO2 diagrams, EPTs vs Fe show good linear (inverse) correlation with most of these health-risk elements. Fe concentrations determined magnetically from room-temperature susceptibility measurements agrees with those obtained by traditionally geochemical methods.

  18. A multi-state approach to black-tailed prairie dog conservation and management in the United States (Enfoque multi-estatal para la Conservacion y manejo del perro llanero de cola negra en los Estados Unidos)

    Treesearch

    Robert J. Luce

    2006-01-01

    The black-tailed prairie dog (Cynomys ludovicianus) is unusual among species proposed for Endangered Species Act (ESA) listing in that several million individuals currently exist across a large area in the wild. The National Wildlife Federation's 1998 listing petition estimated the current area occupied by the species at 283,500-324,000 ha. Although widespread,...

  19. [Management of non-ST-segment-elevation acute coronary syndromes in Spain. The DESCARTES (Descripción del Estado de los Síndromes Coronarios Agudos en un Registro Temporal ESpañol) study].

    PubMed

    Bueno, Héctor; Bardají, Alfredo; Fernández-Ortiz, Antonio; Marrugat, Jaume; Martí, Helena; Heras, Magda

    2005-03-01

    There is little information regarding the management of non-ST segment elevation acute coronary syndromes (NSTE ACS) in Spain from a population-based perspective. Our objective was to study the status of clinical care in patients with NSTE ACS in Spain from a representative perspective of the situation on a national level. A prospective registry was used for consecutive patients with NSTE ACS admitted to 52 Spanish hospitals with different cardiological facilities. Centers that fulfilled the quality control criteria for the study were randomly selected for inclusion. Between April and May, 2002, 1877 patients were recruited. Median age was 69 years, 93% had at least one risk factor and 73% had antecedents of cardiovascular disease. The electrocardiogram on admission was abnormal in 76% of the cases, and troponin levels were elevated in 53%. Twenty-seven percent of the patients were admitted to a cardiac care unit or intensive care unit. The rates of use of diagnostic techniques were: echocardiography 56%; non-invasive test for detection of ischemia 39%; coronary angiography 41%. During hospitalization, 24% underwent coronary revascularization, 88% received aspirin, 81% heparin, 37% clopidogrel, 12% glycoprotein IIb/IIIa inhibitors, 63% ss-blockers, 46% angiotensin-converting enzyme inhibitors, and 52% statins. The final diagnosis was angina in 54%, myocardial infarction in 28%, and other in 18%. Mortality was 3.7% at 28 days and 7.8% at 6 months. DESCARTES is the first representative registry of NSTE ACS management in Spain. It shows that despite their high-risk profile, these patients receive suboptimal medical care according to current clinical recommendations.

  20. [Food consumption and the nutritional status of schoolchildren of the Community of Madrid (CAENPE): general methodology and overall food consumption. Consumo de alimentos y estado nutricional de la población escolar].

    PubMed

    Vázquez, C; de Cos, A I; Martínez, P; Jaunsolo, M A; Román, E; Gómez, C; López, T; Hernáez, I; Seijas, V; Ramos, V

    1995-01-01

    The CAENPE study (Food Consumption and Nutritional State of the School Population) was a transversal observational study funded and promoted by the Directorate-General of Food Hygiene in the Ministry of Health, implemented in 1991-93, with the main aim of quantifying food consumption in the school population (6-14 years of age) in the Regional Community of Madrid, together with an anthropometric study and nutritional analysis of that population. This project sets our the General Methodology for the study, paying particular attention to the sampling design, to ensure that the sample is representative of the community, and the results of the overall consumption of food and its comparison with recommended diet and other population studies. Quantification shows a high and rising consumption of meat, meat products, sweets, snacks and prepared dishes, suitable consumption of eggs, legumes and fruit and a notable lack of greens, vegetables and potatoes. The basic results underline the need to introduce educational measures with practical effect on home and school menus.

  1. Opportunities at Independent Colleges and Universities in New York State through the Higher Education Opportunity Program = Las Oportunidades en las Instituciones Independendientes de Nivel Universitario en el Estado de Nueva York a traves de los Programas de Oportunidades Educativas Universitarias.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of Higher Education Opportunity Programs.

    A guide to the opportunities at private colleges and universities in New York State through the Higher Education Opportunity Program (HEOP) is presented. The HEOP is designed to meet the special needs of students from disadvantaged backgrounds through screening, testing, counseling, tutoring, teaching, and financial assistance. Generally, students…

  2. Opportunities at Independent Colleges and Universities in New York State through the Higher Education Opportunity Program = Oportunidades en los colegios y universidades independientes en el Estado de Nueva York a traves de los programas de oportunidad en educacion.

    ERIC Educational Resources Information Center

    State Univ. of New York, Albany.

    Information on programs that address special needs of students from disadvantaged backgrounds who attend private colleges and universities in New York State is provided in separate English and Spanish reports. The Higher Education Opportunity Program (HEOP) provides supportive services and financial aid. Information is provided on: eligibility for…

  3. PROCENTAJE DE PSILIDOS PORTADORES DE Canidatus Liberibacter asiaticus Y SU RELACION CON LA INCIDENCIA DE HLB EN CINCO HUERTAS COMERCIALES DE LIMON MEXICANO {Citrus aurantifolia (Christm) Swingle} EN EL ESTADO DE COLIMA MEXICO

    USDA-ARS?s Scientific Manuscript database

    Asian citrus psyllids (Diaphorina citri) were individually analyzed by qPCR to detect Candidatus Liberibacter asiaticus (CLas). The psyllids were collected in Mexican lime (Citrus aurantifolia) trees in five commercial orchards in Tecomán and Manzanillo, Colima with severe symptoms of classical mott...

  4. La Naturaleza del Estado Cubano y el Llamado a La Inversion Extranjera: Crisis o Invitacion al Cambio (The Nature of the Cuban State and the Call for Foreign Investment: Crisis or Invitation to Change).

    ERIC Educational Resources Information Center

    Campbell, Luis E. Hartly

    1995-01-01

    Presents a study of the period of crisis in modern Cuba dating back to 1991. An overview of the Cuban character is given in order to promote understanding of the environment that has permitted the present socialist government to remain in power since 1959. It is concluded that Cuba requires massive foreign investment in every sector for its…

  5. Guia para estudiantes: Ayuda economica del Departamento de Educacion de los Estados Unidos, 2003-2004 (The Student Guide: Financial Aid from the U.S. Department of Education, 2003-2004).

    ERIC Educational Resources Information Center

    Office of Federal Student Aid (ED), Washington, DC.

    This Spanish language publication explains what federal student financial aid is and the types of student financial aid that are available. The guide opens with an overview of federal student financial aid, and then discusses how to find out about student aid. A section of general information discusses eligibility and dependency. Types of federal…

  6. Libros bilingues, traducciones desparpajadas y traducciones pobres: libros en espanol publicados en los Estados Unidos (Bilingual Books, Careless Translations, and Bad Translations: Books in Spanish Published in the United States).

    ERIC Educational Resources Information Center

    Schon, Isabel

    2003-01-01

    Discusses the importance of providing Spanish-speaking students with high-quality reading materials in Spanish and avoiding materials that have been badly translated into Spanish. Provides an annotated list of 10 books recommended for young children and a Spanish grammar for more advanced readers. Lists 29 badly translated books. Describes a Web…

  7. Un Nuevo Convenio para el Aprendizaje: Una Sociedad para Mejorar los Resultados Educativos en el Estado de Nueva York (A New Compact for Learning: A Partnership To Improve Educational Results in New York State).

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Office of Elementary, Middle and Secondary Education.

    This Spanish translation of the abridged version of "A New Compact for Learning" acknowledges the current U.S. education system's inadequacy to educate U.S. citizenry and introduces New York State's New Compact for Learning, intended as a plan to reorganize New York's own system. The compact's fundamental principles are: (1) recognizing…

  8. Opportunities at Independent Colleges and Universities in New York State through the Higher Education Opportunity Program = Oportunidades en los colegios y universidades independientes en el Estado de Nueva York a traves de los programas de oportunidad en educacion.

    ERIC Educational Resources Information Center

    State Univ. of New York, Albany.

    Information on programs that address special needs of students from disadvantaged backgrounds who attend private colleges and universities in New York State is provided in separate English and Spanish reports. The Higher Education Opportunity Program (HEOP) provides supportive services and financial aid. Information is provided on: eligibility for…

  9. Opportunities at Independent Colleges and Universities in New York State through the Higher Education Opportunity Program = Las Oportunidades en las Instituciones Independendientes de Nivel Universitario en el Estado de Nueva York a traves de los Programas de Oportunidades Educativas Universitarias.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany. Bureau of Higher Education Opportunity Programs.

    A guide to the opportunities at private colleges and universities in New York State through the Higher Education Opportunity Program (HEOP) is presented. The HEOP is designed to meet the special needs of students from disadvantaged backgrounds through screening, testing, counseling, tutoring, teaching, and financial assistance. Generally, students…

  10. Reaching Higher. A Parent's Guide to the Washington Assessment of Learning. Revised = Para llegar mas arriba. Una guia para padres sobre la evaluacion del aprendizaje de los estudiantes del estado de Washington (Washington Assessment of Student Learning). Revisado.

    ERIC Educational Resources Information Center

    Washington Office of the State Superintendent of Public Instruction, Olympia.

    This guide in English and Spanish is designed to answer questions parents may have about the Washington Assessment of Student Learning (WASL), including how it will help improve their children's education, how it is scored, and how to use the information it provides. In Washington, clear educational goals for subject content, thinking skills, and…

  11. Libros bilingues, traducciones desparpajadas y traducciones pobres: libros en espanol publicados en los Estados Unidos (Bilingual Books, Careless Translations, and Bad Translations: Books in Spanish Published in the United States).

    ERIC Educational Resources Information Center

    Schon, Isabel

    2003-01-01

    Discusses the importance of providing Spanish-speaking students with high-quality reading materials in Spanish and avoiding materials that have been badly translated into Spanish. Provides an annotated list of 10 books recommended for young children and a Spanish grammar for more advanced readers. Lists 29 badly translated books. Describes a Web…

  12. La Naturaleza del Estado Cubano y el Llamado a La Inversion Extranjera: Crisis o Invitacion al Cambio (The Nature of the Cuban State and the Call for Foreign Investment: Crisis or Invitation to Change).

    ERIC Educational Resources Information Center

    Campbell, Luis E. Hartly

    1995-01-01

    Presents a study of the period of crisis in modern Cuba dating back to 1991. An overview of the Cuban character is given in order to promote understanding of the environment that has permitted the present socialist government to remain in power since 1959. It is concluded that Cuba requires massive foreign investment in every sector for its…

  13. Factors influencing tropical island freshwater fishes:Species, status, and management implications in puerto rico [Factores que influencian a los peces tropicales de agua dulce: Especies, estado actual e implicaciones para el manejo en Puerto Rico

    USGS Publications Warehouse

    Wesley, Neal J.; Lilyestrom, C.G.; Kwak, T.J.

    2009-01-01

    Anthropogenic effects including river regulation, watershed development, contamination, and fish introductions have substantially affected the majority of freshwater habitats in Europe and North America. This pattern of resource development and degradation is widespread in the tropics, and often little is known about the resources before they are lost. This article describes the freshwater resources of Puerto Rico and identifies factors that threaten conservation of native fishes. The fishes found in freshwater habitats of Puerto Rico represent a moderately diverse assemblage composed of 14 orders, 29 families, and 82 species. There are fewer than 10 species of native peripherally-freshwater fish that require a link to marine systems. Introductions of nonindigenous species have greatly expanded fish diversity in freshwater systems, and native estuarine and marine species (18 families) also commonly enter lowland rivers and brackish lagoons. Environmental alterations, including land use and development, stream channelization, pollution, and the impoundment of rivers, combined with nonnative species introductions threaten the health and sustainability of aquatic resources in Puerto Rico. Six principal areas for attention that are important influences on the current and future status of the freshwater fish resources of Puerto Rico are identified and discussed.

  14. Reporting of ethical committee approval and patient consent in the Portuguese Journal of Pulmonology and in the other Portuguese medical journals with impact factor.

    PubMed

    Bernardes, M J; Nunes, R

    2012-01-01

    Reporting of ethical committee (EC) approval and patient consent in publications involving human subjects may be lower than recommended. In this paper this ethical issue was analysed in the Portuguese Journal of Pulmonology and in the other two Portuguese medical journals with impact factor indexed in the ISI Web of Knowledge. Reporting of EC approval and patient consent was searched in all publications involving human subjects published in the Acta Médica Portuguesa, Acta Reumatológica Portuguesa and Portuguese Journal of Pulmonology, from the 1(st) July 2010 until the 30(th) June 2011. The search also looked for the involvement of vulnerable and potentially identifiable subjects. Most of the analysed publications, which included a considerable proportion of vulnerable (23%) and of potentially identifiable case reports (14%), were case reports (49%). Overall EC approval ranged from 0% to 28%, in case reports and prospective studies, respectively, whereas overall patient consent ranged from 0% to 26%. There were not statistically significant differences in results among the selected journals. Reporting of EC approval and patient consent in the three leading Portuguese medical journals has been lower than in their leading world counterparts. This should be taken into account and further audited in future, not only for the protection of the research subjects but also to maintain public trust in the process. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  15. 75 FR 34214 - Additional Designations, Foreign Narcotics Kingpin Designation Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-16

    ..., Nueva Italia, Estado de Michoac n, Mexico; Esquina de Ignacio Allende Numero Y Lazaro Cardenas Norte Numero 500, Nueva Italia, Estado de Michoac n, Mexico; (ENTITY) Dated: June 9, 2010. Adam J. Szubin...

  16. Translation, Cultural Adaptation and Validation of the Power of Food Scale for Use by Adult Populations in Portugal.

    PubMed

    Ribeiro, Gabriela; Santos, Osvaldo; Camacho, Marta; Torres, Sandra; Mucha-Vieira, Filipa; Sampaio, Daniel; Oliveira-Maia, Albino J

    2015-01-01

    Introdução: A Power of Food Scale é uma escala que avalia um constructo designado por fome hedónica, frequentemente definido como o apetite por alimentos de elevada palatibilidade, mais do que a sua ingestão propriamente dita. Este estudo teve como objetivo a caracterização das propriedades psicométricas de uma versão portuguesa da Power of Food Scale, nomeadamente da sua fiabilidade e validade de constructo. Material e Métodos: Os dados foram obtidos de 1266 participantes adultos, provenientes de três amostras distintas: duas amostras não clínicas e uma amostra clínica de indivíduos com obesidade severa, candidatos a cirurgia da obesidade. Resultados: Verificamos que a estrutura factorial da versão portuguesa da Power of Food Scale é semelhante à do questionário original e que apresenta fiabilidade teste-reteste e validade de constructo adequadas. Adicionalmente, apresentamos neste estudo o primeiro contributo para a definição de normas populacionais para os scores da Power of Food Scale. Discussão: A versão portuguesa da Power of Food Scale apresentou boas propriedades psicométricas: é um instrumento válido e fiável para a avaliação do constructo fome hedónica, suportando a sua utilização tanto em amostras clínicas como não clínicas, bem como em estudos longitudinais. Conclusão: Estes resultados demostram que a versão portuguesa da Power of Food Scale é um instrumento útil, tanto em contexto clínico, como de investigação, nomeadamente para o estudo do constructo fome hedónica em populações de língua portuguesa, incluindo populações clínicas de indivíduos com obesidade.

  17. Fish assemblages of the Casiquiare River, a corridor and zoogeographical filter for dispersal between the Orinoco and Amazon basins

    USGS Publications Warehouse

    Winemiller, K.O.; Lopez-Fernandez, H.; Taphorn, D.C.; Nico, L.G.; Duque, A.B.

    2008-01-01

    Aim: The aim of this study was to determine whether the Casiquiare River functions as a free dispersal corridor or as a partial barrier (i.e. filter) for the interchange of fish species of the Orinoco and Negro/Amazon basins using species assemblage patterns according to geographical location and environmental features. Location: The Casiquiare, Upper Orinoco and Upper Negro rivers in southern Venezuela, South America. Methods: Our study was based on an analysis of species presence/absence data and environmental information (11 habitat characteristics) collected by the authors and colleagues between the years 1984 and 1999. The data set consisted of 269 sampled sites and 452 fish species (> 50,000 specimens). A wide range of habitat types was included in the samples, and the collection sites were located at various points along the entire length of the Casiquiare main channel, at multiple sites on its tributary streams, as well as at various nearby sites outside the Casiquiare drainage, within the Upper Orinoco and Upper Rio Negro river systems. Most specimens and field data used in this analysis are archived in the Museo de Ciencias Naturales in Guanare, Venezuela. We performed canonical correspondence analysis (CCA) based on species presence/absence using two versions of the data set: one that eliminated sites having < 5 species and species occurring at < 5 sites; and another that eliminated sites having < 10 species and species occurring at < 10 sites. Cluster analysis was performed on sites based on species assemblage similarity, and a separate analysis was performed on species based on CCA loadings. Results: The CCA results for the two versions of the data set were qualitatively the same. The dominant environmental axis contrasted assemblages and sites associated with blackwater vs. clearwater conditions. Longitudinal position on the Casiquiare River was correlated (r2 = 0.33) with CCA axis-1 scores, reflecting clearwater conditions nearer to its origin

  18. Intramural coronary hematoma, a complex three-dimensional entity: Multimodality assessment.

    PubMed

    Núñez-Gil, Iván J; Echavarría-Pinto, Mauro; Feltes, Gisela; Fernández-Ortiz, Antonio

    2017-04-01

    A 62-year-old woman was admitted with chest pain of two hours' duration, ECG changes in the precordial leads and left ventricular ejection fraction of 30% on the echocardiogram. Emergent catheterization demonstrated severe flow disturbance in the left coronary artery. An intra-aortic balloon pump and a drug-eluting stent were implanted. However, the flow disturbance persisted. Optical coherence tomography followed by intravascular ultrasound provided crucial data on the mechanism and helped to optimize treatment in this critical patient. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. A rare case of concomitant stress (takotsubo) cardiomyopathy and acute myocardial infarction.

    PubMed

    Menezes, Miguel Nobre; Silva, Doroteia; Almeida, Ana G; Pinto, Fausto J; Brito, Dulce

    2015-01-01

    Stress cardiomyopathy and myocardial infarction are generally regarded as mutually exclusive diagnoses. We report the case of a 54-year-old woman who presented with acute chest pain. Her echocardiogram and ventriculography were typical of stress cardiomyopathy, but she had one subocclusive coronary lesion, a highly significant rise in troponin and a subendocardial myocardial infarction scar documented on cardiac magnetic resonance. This is a rare case of concomitant myocardial infarction and stress cardiomyopathy, in which the acute coronary syndrome itself may have been the stressor, given the absence of other identifiable causes. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. A rare cause of acute coronary syndrome: Kounis syndrome.

    PubMed

    Almeida, João; Ferreira, Sara; Malheiro, Joana; Fonseca, Paulo; Caeiro, Daniel; Dias, Adelaide; Ribeiro, José; Gama, Vasco

    2016-12-01

    Kounis syndrome is an acute coronary syndrome in the context of a hypersensitivity reaction. The main pathophysiological mechanism appears to be coronary vasospasm. We report the case of a patient with a history of allergy to quinolones, who was given ciprofloxacin before an elective surgical procedure and during drug administration developed symptoms and electrocardiographic changes suggestive of ST-segment elevation acute coronary syndrome. The drug was suspended and coronary angiography excluded epicardial coronary disease. Two hours after withdrawal of the drug the symptoms and ST elevation had resolved completely. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Percutaneous closure of isolated ostium secundum-type atrial septal defect in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.

    PubMed

    Akcay, Murat; Gulel, Okan; Soylu, Korhan; Meric, Murat; Elmali, Muzaffer

    2016-12-01

    Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital anomaly characterized by complete or partial aplasia of the uterus and the upper part of the vagina. It is reported to be associated with cardiovascular disorders including atrial septal defect, anomalous pulmonary venous return, aortopulmonary window, pulmonary valve stenosis, mitral valve prolapse, tetralogy of Fallot, truncus arteriosus, and patent ductus arteriosus. Herein, for the first time in the medical literature, we present percutaneous closure of an isolated ostium secundum atrial septal defect in this syndrome. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Measuring emotional awareness from a cognitive-developmental perspective: Portuguese adaptation studies of the levels of emotional awareness scale.

    PubMed

    Torrado, Marco; Ouakinin, Sílvia; Lane, Richard

    2013-01-01

    Introdução: A Escala de Níveis de Consciência Emocional (LEAS) foi desenvolvida para avaliar o constructo consciência emocional, numa perspectiva cognitivo-desenvolvimentista e influenciada pelas Teorias de Piaget e Werner. É composta por 20 situações ou cenários que evocam emoções e tem sido usada em múltiplas investigações nos domínios da regulação emocional, alexitimia e perturbações psiquiátricas. Trata-se de uma medida bem documentada, validada e precisa. Em virtude da sua extensão, alguns investigadores têm vindo a utilizar uma das formas paralelas que compõe a versão completa, a LEAS-A, sendo contudo notória a vacuidade de estudos que descrevam as qualidades psicométricas desta versão. Face à inexistência de uma medida de caracterização da organização da experiência emocional para a população portuguesa, desenvolveu-se a versão portuguesa da LEAS, caracterizaram-se diversos indicadores de precisão e validade, assim como para a versão reduzida LEAS-A. Materiais e Métodos: Foram desenvolvidos três estudos com estas versões, dois deles com recurso a estudantes universitários e um outro com uma amostra da população em geral. Resultados: A versão portuguesa demonstrou níveis elevados de precisão, mais robustos do que os encontrados em estudos de adaptação da escala noutros países. A LEAS-A apresentou bons níveis de precisão e indicadores de validade discriminante e concorrente. As pontuações obtidas na LEAS-A mostraram-se independentes da presença de afecto negativo e associaram-se significativamente a um estilo cognitivo externalizado, próprio do funcionamento alexitímico. Conclusões: As versões portuguesas da LEAS e da LEAS-A apresentam qualidades psicométricas muito adequadas, o que permite o seu uso científico. São discutidas as implicações da sua utilização nos contextos clínico e de investigação.

  3. Prevalence of isolated systolic hypertension in the population over 55 years old. Results from a national study.

    PubMed

    Clara, J Gorjão; De Macedo, Mário Espiga; Pego, Mariano

    2007-01-01

    Isolated systolic hypertension (ISH) is an important risk factor for cardiovascular events (myocardial infarction and stroke) and premature mortality, particularly in the elderly population. Among this population, it is an even better predictor of morbidity and mortality than diastolic blood pressure (BP). This cooperative survey was promoted by the World Hypertension League, Associação Portuguesa de Hipertensão, Instituto Nacional de Cardiologia Preventiva, Sociedade Portuguesa de Cardiologia, Sociedade Portuguesa de Geriatria, Sociedade Portuguesa de Medicina Intema, and Direcção Geral de Saúde, with the collaboration of Servier Portugal. The aim of this survey was to evaluate the prevalence of ISH within the Portuguese elderly population (aged 55+) during the year 2000, compared and together with other countries, in order to estimate its worldwide prevalence. Secondary objectives were to investigate demographic factors related to ISH (age, gender and other cardiovascular risk factors) and to analyze the effects of repeated blood pressure measurements on prevalence and on postural variations in blood pressure. We performed a survey including 108 primary care centers. General practitioners were invited to include the first consecutive 15 patients aged over 55 years. Subjects were be selected over a period of one week and had to agree to attend three visits. All blood pressure measurements were to be performed in accordance with the standards of the 7th Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). 1031 subjects were included in this survey. We concluded that ISH prevalence ranges between 20.3% in primary" care patients and 35% in the community, using mean values of both systolic and diastolic BP. ISH prevalence is higher among women; it increases with age, decreasing slightly after the age of 70. Risk factors include gender, age and family history of hypertension. The predictive value for ISH

  4. Consensus document for the prevention of respiratory infections in adults.

    PubMed

    Froes, F; Diniz, A; Robalo Cordeiro, C; Serrado, M; Ramalho de Almeida, A

    2014-01-01

    Infectious diseases are one of the principle causes of morbidity, mortality and drain on health resources worldwide. In recent years there has been an increase in the impact of respiratory infections, particularly in the Portuguese population. It is for this reason that the Portuguese Respiratory Society has presented a series of recommendations for the prevention of respiratory infections in adults. These recommendations include both general measures and vaccinations for flu and pneumococcal pneumonia. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  5. An unusual presentation of peripartum cardiomyopathy: Recurrent transient ischemic attacks.

    PubMed

    Zehir, Regayip; Karabay, Can Yucel; Kocabay, Gonenc; Kalayci, Arzu; Akgun, Taylan; Kirma, Cevat

    2014-09-01

    Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy that is associated with high maternal morbidity and mortality. Onset is usually between the last month of pregnancy and up to the fifth month postpartum. PPCM usually presents with signs and symptoms of heart failure and rarely with thromboembolic complications. The true incidence of thromboemboli in PPCM is unknown. Herein we report an unusual case of PPCM in a previously healthy woman who presented with recurrent transient ischemic attacks due to thrombus in the left ventricle. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  6. Pacemaker lead-related tricuspid stenosis successfully treated with percutaneous balloon valvuloplasty guided by 3D echocardiography.

    PubMed

    Rama-Merchan, Juan Carlos; Arribas-Jimenez, Antonio; Martin-Moreiras, Javier; Garcia-Fernandez, Eulogio; Cruz-Gonzalez, Ignacio

    2014-11-01

    The most common etiology of tricuspid stenosis is rheumatic, and in most cases it is associated with valvular regurgitation. Interestingly, there have been reports of tricuspid stenosis without associated valvular regurgitation, mostly related to pacemaker leads. Percutaneous tricuspid valvuloplasty may be a therapeutic alternative to surgery in cases of pure tricuspid stenosis without other concomitant valvulopathies. We report the case of a 52-year-old woman with pacemaker lead-related tricuspid stenosis successfully treated with percutaneous valvuloplasty guided by 3D echocardiography. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. [Giant tumoral lesion in the left atrium: an uncommon case of undifferentiated cardiac sarcoma].

    PubMed

    Ferreira, Catarina; Martins, Daniel; Pereira, Rodolfo; Ribeiro, Hélder; Neves, Fátima; Mateus, Pedro; Moreira, Ilídio; Vouga, Luís

    2013-09-01

    Primary cardiac tumors are rare, with an incidence ranging from 0.0001% to 0.030%; 80% are benign, while sarcomas account for 95% of malignant tumors. The authors report the case of a 75-year-old patient with a giant mass in the left atrium. The final diagnosis was of an undifferentiated cardiac sarcoma. This tumor represents a real challenge not only for timely diagnosis, but especially the therapeutic approach to adopt. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Establishment of heart teams in Portugal.

    PubMed

    Sousa Uva, M; Leite Moreira, A; Gavina, C; Pereira, H; Lopes, M G

    2014-01-01

    Whenever several therapeutic options exist, multidisciplinary decision-making is beneficial for the patient and for society at large. The main obstacles to the establishment of heart teams in Portugal are organizational and logistical. Implementing a heart team approach entails definition of the situations requiring multidisciplinary discussion, creation of clear lines of communication, written protocols and obtaining patient informed consent. The European Society of Cardiology guidelines define the clinical scenarios where intervention of the heart team is recommended. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Multiple left ventricular aneurysms in a young female.

    PubMed

    Raval, Abhishek P; Shukla, Anand; Garg, Rajiv; Rana, Yashpal; Shah, Komal

    2016-02-01

    Multiple left ventricular aneurysms (LVAs) are rare, especially in a young female. A 29-year-old woman presented vague symptoms. Multiple LVAs were revealed and confirmed on different imaging modalities, including chest radiography, echocardiography, contrast ventriculography and cardiac magnetic resonance imaging. Detailed work-up for probable etiologies including ischemic, infectious, inflammatory and autoimmune causes was negative. In the absence of angina, decompensated congestive heart failure, arrhythmias and embolism, the patient was managed conservatively, with excellent mid-term outcome. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Content Questions In American Sign Language: An RRG Analysis

    DTIC Science & Technology

    2004-12-08

    Canada (Québec) Lengua de Señas Argentina Argentina Lengua de Señas Española Spain (except Catalonia) Lingua Gestual Portuguesa Portugal Lingua...clause initial or it may appear in both positions. In example (11) from Lengua de Señas Española (Spain), the question particle is transcribed as SI/NO...In the example from Finnish Sign Language (12), the question particle is transcribed as PALM-UP (Zeshan 2004): (11) Lengua de Señas Española

  11. Seasonal reproductive biology of two species of freshwater catfish from the Venezuelan floodplains.

    PubMed

    Marcano, Dayssi; Cardillo, Elizabeth; Rodriguez, Christian; Poleo, Germán; Gago, Nathalie; Guerrero, Hilda Y

    2007-01-01

    Oxydoras sifontesi and Pimelodus blochii are seasonal breeder fish. Spawn occurs once a year over a short interval of time, at the beginning of the rainy season. The gonadosomatic index (GSI), and plasma levels of steroid hormones of P. blochii and O. sifontesi were studied from fish samples, collected from the Portuguesa River (Portuguesa State, Venezuela) in 1998 and 2004-2005, respectively. Gonadal tissue samples were obtained and processed for histology. A macroscopic classification of the degree of gonadal maturation was performed using a six-stage maturity scale. Data was analyzed and compared as a function of the gonadal maturation stage. The GSI of both O. sifontesi and P. blochii increases from stages II to V (preparatory and prespawning periods) and decreases in the stage VI (postspawning). In males, the GSI was usually lower than in females. In both species, the higher plasmatic concentration of 17beta-estradiol (17beta-E) and testosterone (T) were obtained from specimens in stages IV or V. A significant decrease in both hormones was observed in stage VI, except for the males of P. blochii where T concentration did not change between gonadal stages IV-VI. The relevance of these results is discussed in relation to the seasonality and the particular hydrological conditions of the region.

  12. Educacion Bilingue: Una Declaracion del Plan y Accion que Proponen los Regentes de la Universidad del Estado de Nueva York (Bilingual Education: A Statement of Policy and Proposed Action by the Regents of the University of the State of New York.)

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany.

    The primary goal of the Regents in their bilingual education program is to provide equal educational opportunity for non-English-speaking children through activities capitalizing on their proficiency in their native language and developing competency in English. Two complementary goals are inherent: (1) a vitally needed national resource, the…

  13. Palabras del Secretario de Educacion Publica en la reunion anual de directores de education federal e inspectores generales en los estados que se rigen por el calendario "A". (Address by the Minister of Education at the Annual Meeting of Directors of Federal Education and Inspectors General in Calendar "A" States).

    ERIC Educational Resources Information Center

    Yanez, Agustin

    This document is an English-language abstract (approximately 1,500 words) of a speech by the Mexican Minister of Education at an annual educators meeting. The Minister dealt with the administration and quality of education, the role of the directors and the duties towards them of the inspectors, and the main features of the reform of national…

  14. Educacion Bilingue: Una Declaraccion del Plan y Accion que Proponen los Regentes de la Universidad del Estado de Nueva York. Bilingual Education: A Statement of Policy and Proposed Action by the Regents of the University of the State of New York. Position Paper No. 16.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany.

    Large numbers of Puerto Rican and other non-English-speaking students live in school districts throughout New York State. To enable these students to function in an English-speaking society while retaining their own culture, a policy to promote bilingual program planning was established by the Board of Regents of New York State in 1972. In this…

  15. Proyecto Curricular Sobre la Herencia Iberoamericana. Latinos en la Formacion de los Estados Unidos de American: Ayer, Hoy y Manana. Procedimientos de la Conferencia Sequnda Conferencia Anual del Panel Consultivo Internacional en Santillana del Mar, Espana (The Ibero-American Heritage Curriculum Project. Latinos in the Making of the United States of America: Yesterday, Today, and Tomorrow).

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany.

    The Ibero-American Heritage Curriculum Project is an interdisciplinary curriculum development project designed to integrate the study of Ibero-American heritage and culture into classroom instructional programs, kindergarten through grade 12. The project was initiated by the New York State Education Department and involves the Spanish National…

  16. Una Guia para Los Padres sobre La Educacion Especial: El Derecho de Su Hijo(a) a Adquirir una Educacion en el Estado de Nueva York (A Parent's Guide to Special Education: Your Child's Right to an Education in New York State).

    ERIC Educational Resources Information Center

    New York State Education Dept. Albany. Office for the Education of Children with Handicapping Conditions.

    This guide provides information to help parents of special needs children in New York become active partners in the planning and implementation of special education programs. The first part of the guide provides in-depth information related to the special education process in New York State public schools. A historical view of children's rights to…

  17. El Derecho de su Hijo(a) a Una Educacion: Una guia para los Padres de Ninos Impedidos en el Estado de Nueva York (Your Child's Right to an Education: A Guide for Parents of Children with Handicapping Conditions in New York State).

    ERIC Educational Resources Information Center

    New York State Education Dept. Albany. Office for the Education of Children with Handicapping Conditions.

    Intended for parents of handicapped students, the guide (available in English, Spanish, or Chinese) sets forth the New York State policies for speical education. The following topics are among those considered: eligibility for special education, program types, alternative placements (such as residential settings), referral, evaluation,…

  18. Los Hispanos: Problemas y Oportunidades. Resumen de la Actual Situacion Demografica, Economica, Social y Politica de los Hispanos en los Estados Unidos y de las Iniciativas Tomadas por la Fundacion Ford Para Hacer Frente a las Necesidades de esta Poblacion en Aumento y Determinar sus Efectos Sobre la Sociedad Estadounidense. Documento de Trabajo de la Fundacion Ford, No. 436.

    ERIC Educational Resources Information Center

    Ford Foundation, New York, NY.

    The Hispanic population's growing impact on American society has caused the Ford Foundation to explore new Foundation initiatives. The 1980 census revealed 14.6 million Hispanics: 60% Mexican American; 14% Puerto Rican; 6% Cuban, and 20% Other. The Hispanic population in the United States is growing and is characterized by diversity; rapid growth…

  19. Los Hispanos: Problemas y Oportunidades. Resumen de la Actual Situacion Demografica, Economica, Social y Politica de los Hispanos en los Estados Unidos y de las Iniciativas Tomadas por la Fundacion Ford Para Hacer Frente a las Necesidades de esta Poblacion en Aumento y Determinar sus Efectos Sobre la Sociedad Estadounidense. Documento de Trabajo de la Fundacion Ford, No. 436.

    ERIC Educational Resources Information Center

    Ford Foundation, New York, NY.

    The Hispanic population's growing impact on American society has caused the Ford Foundation to explore new Foundation initiatives. The 1980 census revealed 14.6 million Hispanics: 60% Mexican American; 14% Puerto Rican; 6% Cuban, and 20% Other. The Hispanic population in the United States is growing and is characterized by diversity; rapid growth…

  20. Palabras del Secretario de Educacion Publica en la reunion anual de directores de education federal e inspectores generales en los estados que se rigen por el calendario "A". (Address by the Minister of Education at the Annual Meeting of Directors of Federal Education and Inspectors General in Calendar "A" States).

    ERIC Educational Resources Information Center

    Yanez, Agustin

    This document is an English-language abstract (approximately 1,500 words) of a speech by the Mexican Minister of Education at an annual educators meeting. The Minister dealt with the administration and quality of education, the role of the directors and the duties towards them of the inspectors, and the main features of the reform of national…

  1. Una Guia para Los Padres sobre La Educacion Especial: El Derecho de Su Hijo(a) a Adquirir una Educacion en el Estado de Nueva York (A Parent's Guide to Special Education: Your Child's Right to an Education in New York State).

    ERIC Educational Resources Information Center

    New York State Education Dept. Albany. Office for the Education of Children with Handicapping Conditions.

    This guide provides information to help parents of special needs children in New York become active partners in the planning and implementation of special education programs. The first part of the guide provides in-depth information related to the special education process in New York State public schools. A historical view of children's rights to…

  2. El Derecho de su Hijo(a) a Una Educacion: Una guia para los Padres de Ninos Impedidos en el Estado de Nueva York (Your Child's Right to an Education: A Guide for Parents of Children with Handicapping Conditions in New York State).

    ERIC Educational Resources Information Center

    New York State Education Dept. Albany. Office for the Education of Children with Handicapping Conditions.

    Intended for parents of handicapped students, the guide (available in English, Spanish, or Chinese) sets forth the New York State policies for speical education. The following topics are among those considered: eligibility for special education, program types, alternative placements (such as residential settings), referral, evaluation,…

  3. Proyecto Curricular Sobre la Herencia Iberoamericana. Latinos en la Formacion de los Estados Unidos de American: Ayer, Hoy y Manana. Procedimientos de la Conferencia Sequnda Conferencia Anual del Panel Consultivo Internacional en Santillana del Mar, Espana (The Ibero-American Heritage Curriculum Project. Latinos in the Making of the United States of America: Yesterday, Today, and Tomorrow).

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany.

    The Ibero-American Heritage Curriculum Project is an interdisciplinary curriculum development project designed to integrate the study of Ibero-American heritage and culture into classroom instructional programs, kindergarten through grade 12. The project was initiated by the New York State Education Department and involves the Spanish National…

  4. Educacion Bilingue: Una Declaraccion del Plan y Accion que Proponen los Regentes de la Universidad del Estado de Nueva York. Bilingual Education: A Statement of Policy and Proposed Action by the Regents of the University of the State of New York. Position Paper No. 16.

    ERIC Educational Resources Information Center

    New York State Education Dept., Albany.

    Large numbers of Puerto Rican and other non-English-speaking students live in school districts throughout New York State. To enable these students to function in an English-speaking society while retaining their own culture, a policy to promote bilingual program planning was established by the Board of Regents of New York State in 1972. In this…

  5. Validation of the Portuguese Version of EHP-30 (The Endometriosis Health Profile-30).

    PubMed

    Nogueira-Silva, Cristina; Costa, Patrício; Martins, Carla; Barata, Sónia; Alho, Conceição; Calhaz-Jorge, Carlos; Osório, Filipa

    2015-01-01

    Introdução: O Endometriosis Health Profile Questionnaire-30 é atualmente o questionário mais utilizado para avaliação da qualidade de vida em mulheres com endometriose. O objetivo do presente estudo é avaliar as propriedades psicométricas e validar a versão portuguesa do Endometriosis Health Profile Questionnaire-30.Material e Métodos: Amostra sequencial de conveniência, constituída por 152 doentes com endometriose, de um centro de referência no país, que autopreencheram um questionário sociodemográfico, a versão portuguesa do Endometriosis Health Profile Questionnaire-30 e do Short Form Health Survey 36 Itemâversão 2. Procedeu-se a análise estatística apropriada, com estatística descritiva, análise fatorial, avaliação da consistência interna, correlação item-total e validade convergente (usando o Short Form Health Survey 36 Itemâversão 2).Resultados: A análise fatorial confirmou a validade da estrutura em cinco dimensões do questionário central, explicando uma variância total de 83,2%. A correlação item-total apresentou resultados aceitáveis em todos os itens e a consistência interna foi elevada, com α Cronbach variando de 0,876 a 0,981 nas dimensões do questionário central, e de 0,863 a 0,951 no modular. Demonstrou-se associação negativa significativa entre as dimensões similares do Endometriosis Health Profile Questionnaire-30 e do Short Form Health Survey36 Itemâversão 2. A taxa de preenchimento do questionário foi elevada para todas as dimensões. A perda do bem-estar emocional (no questionário central) e a infertilidade (no modular) apresentaram as pontuações médias mais elevadas e, consequentemente, impacto mais negativo sobre a qualidade de vida.Discussão: São necessários estudos para avaliar a fiabilidade teste-reteste e a sensibilidade à mudança desta versão portuguesa do Endometriosis Health Profile Questionnaire-30.Conclusão: Este estudo demonstra que a versão portuguesa do Endometriosis

  6. An Experiment on Intermittent-Failure Mechanisms.

    DTIC Science & Technology

    1987-03-01

    part by the "Fundagfo de Amparo a Pesquisa do Estado de Sdo Paulo" (FAPESP, Brazil) and in part by the Innovative Science and Technology Office of...Associates (PARA), in part by the "Fundagdo de Amparo a Pesquisa do Estado de Sdo Paulo" (FAPESP, Brazil) and in part by the Innovative Science and

  7. On a High-Performance VLSI Solution to Database Problems.

    DTIC Science & Technology

    1981-08-01

    States Government. The author was supported in part by FAPESP (1976-1980), Fundagio de Amparo d Pesquisa do Estado de Sdo Paulo, Brazil, under Contract...Paulo, FAPESP (Fundagio de Amparo d Pesquisa do Estado de Sdo Paulo), and CNPq (Conselho Nacional de Desenvolvimento Cientaico e Tecnolbgico) for their

  8. Computer Simulation of Mechanical and Physical Properties of Carbon Foam Materials

    DTIC Science & Technology

    2007-12-01

    de Estudios Superiores de Monterrey, Campus Estado de Mexico, Carretera Lago de Guadalupe 3.5 km, Atizapan de Zaragoza, Estado de Mexico, 52926...Campus of the Mexico State): Dr. Serguei Kanaoun, Dr. Oleksander Tkachenko, Dr. Sadegh Babaii. The student of the master program M. A. Garcia

  9. Chile: Civil-Military Relations and Democratic Consolidation

    DTIC Science & Technology

    1998-12-01

    as serving " el estado " (the state) or "la patria" (the country) rather than the government or the population. If the government fails in its...mission to serve " el estado ", then the military has the obligation to judge and correct the situation. These attitudes were formed in the nineteenth

  10. Quality of Recovery after Anesthesia: Validation of the Portuguese Version of the 'Quality of Recovery 15' Questionnaire.

    PubMed

    Sá, Ana Carolina; Sousa, Gabriela; Santos, Alice; Santos, Cristina; Abelha, Fernando José

    2015-01-01

    Introdução: O questionário "Quality of Recovery 15" tem sido utilizado para o estudo da qualidade de recuperação após anestesia. O objetivo deste estudo foi validar a versão Portuguesa do questionário "Quality of Recovery 15". Material e Métodos: Após aprovação pela Comissão de ética institucional, foi realizado um estudo de coorte prospectivo em doentes submetidos a cirurgia eletiva de junho a agosto de 2013. A versão portuguesa do "Quality of Recovery 15" foi aplicada antes da cirurgia (T0) e 24 h após a cirurgia (T1) em 170 doentes. Os doentes incapazes de dar consentimento informado ou com comprometimento cognitivo foram excluídos. Má qualidade de recuperação foi definida para pontuações de "Quality of Recovery 15" em T1 inferiores à média das pontuações de "Quality of Recovery 15" menos 1 desvio padrão. Confiabilidade e discordãncia entre observadores foram avaliadas por meio da correlação intraclasse. Testes não-paramétricos foram utilizados para comparações. Resultados: Observou-se uma correlação negativa entre pontuações de "Quality of Recovery 15" e tempo de internamento na Unidade Pós-Anestésica (p = -0,264, p = 0,004) e tempo de internamento hospitalar (p = -0,274, p = 0,004). Trinta e dois doentes (19%) tiveram má qualidade de recuperação. Os doentes com má qualidade de recuperação tinham mais frequentemente diabetes mellitus e hipertensão arterial e estavam medicados com antidepressivos com mais frequência. Os doentes com má qualidade de recuperação foram mais frequentemente submetidos a anestesia combinada e menos frequente a anestesia geral e locorregional (p = 0,008). O questionário teve boa consistência interna; a confiabilidade do teste-reteste foi boa. Discussão: A versão portuguesa do "Quality of Recovery 15" mostrou boa correlação com a versão original. Conclusão: Este questionário parece ser uma avaliação precisa e confiável para a qualidade de recuperação.

  11. [Percutaneous rheolytic thrombectomy in the treatment of high-risk acute pulmonary embolism: Initial experience of a single center].

    PubMed

    Faria, Rita; Oliveira, Márcia; Ponte, Marta; Pires-Morais, Gustavo; Sousa, Marta; Fernandes, Paula; Rodrigues, Alberto; Braga, Pedro; Gonçalves, Manuel; Gama, Vasco

    2014-06-01

    For years, the treatment of high-risk pulmonary embolism (PE) was based on two well-defined strategies: thrombolysis, whose benefits have been documented in randomized trials, and surgical embolectomy. However, mechanical reperfusion by percutaneous techniques is used in an increasing number of patients, and is a valid therapeutic option when there is a formal contraindication to thrombolysis, as rescue therapy when thrombolysis fails to improve hemodynamics, and/or when emergency surgical thrombectomy is unavailable or contraindicated. This article discusses the indications for the use of percutaneous techniques in PE, reports the initial experience of our center with the AngioJet® thrombectomy device (Possis Medical Inc, Minneapolis, MN, USA) and reviews the available evidence, the most recent recommendations and the main complications associated with this procedure. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. Two potentially fatal surprises in the preoperative assessment of an asymptomatic young adult.

    PubMed

    Lagoeiro Jorge, Antonio José; Alves do Couto, Antonio; Tinoco Mesquita, Evandro; Ribeiro, Mario Luiz; Vale de Souza Junior, Celso; de Andrade Martins, Wolney

    2016-05-01

    Isolated left ventricular non-compaction is a rare disease classified as a primary genetic cardiomyopathy and is characterized by heart failure, systemic embolism and ventricular arrhythmias. The diagnosis is established by Doppler echocardiography. We report the case of an asymptomatic young adult, with no history of heart disease, who underwent preoperative assessment for low-risk orthopedic surgery. The electrocardiogram showed left bundle branch block, which prompted further investigation with Doppler echocardiography, cardiac computed tomography angiography and cardiac magnetic resonance imaging. A diagnosis of isolated left ventricular non-compaction and pulmonary embolism was made. Some aspects of preoperative assessment in low-risk surgical patients are discussed. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Postoperative recurrence of postinfarction true and false ventricular aneurysms.

    PubMed

    Arnáiz-García, María Elena; González-Santos, José María; Iscar-Galán, Alberto; Fernández García-Hierro, José María; Dalmau-Sorlí, María José; López-Rodríguez, Javier

    2016-05-01

    Progressive dyspnea after myocardial infarction can suggests the presence of left ventricular (LV) dysfunction or a left ventricular aneurysm (LVA). Surgical treatment of LVA aims to reduce its volume and to restore the ventricle. Recurrence of LVA after previous repair is extremely rare and the occurrence of concomitant postoperative true and false aneurysms is extraordinary. Surgery is usually challenging because of LV dysfunction and cardiac adherences in reoperations. We describe the simultaneous occurrence in a patient of a recurrent true and false LVA after surgical repair of a postinfarction LVA. Five years postoperatively, the patient remains alive and healthy. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  14. Isolated papillary muscle hypertrophy: A gap in our knowledge of hypertrophic cardiomyopathy?

    PubMed

    Ferreira, Catarina; Delgado, Carlos; Vázquez, María; Trinidad, Carmen; Vilar, Manuel

    2014-06-01

    Increased thickness of left ventricular walls is the predominant characteristic and one of the diagnostic criteria of hypertrophic cardiomyopathy (HCM). This case illustrates an uncommon but important finding of isolated hypertrophy of the papillary muscles (PMs), observed in a young woman in whom an abnormal electrocardiogram was initially detected. During the investigation isolated PM hypertrophy was identified. The structural characteristics of the PMs have received scant attention in this setting and there is little information in the literature on this entity, whose real prevalence and clinical significance remain to be determined. The available information relates solitary PM hypertrophy with an early form or a different pattern of HCM. In this case PM hypertrophy was only detected due to the finding of an abnormal electrocardiogram, which prompted further diagnostic tests and a search for possible etiologies. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Paradoxical embolism associated with Ebstein's anomaly in an adult: case report.

    PubMed

    Melão, Filipa; Correia, Ana Sofia; Maciel, Maria Júlia

    2013-12-01

    Ebstein's anomaly (EA) is a rare congenital malformation of the tricuspid valve, often associated with other cardiac malformations, especially atrial septal defect, which is present in 80-90% of patients and predisposes to paradoxical embolization. We describe the case of a 47-year-old male, a drug abuser, with a known but not investigated cardiac murmur. He presented to the emergency department with worsening exertional dyspnea and fatigue associated with recent recurrent transient ischemic attacks. On brain computed tomography there were multiple non-recent ischemic infarctions. Transthoracic echocardiography showed EA with severely dilated right cardiac chambers, right systolic dysfunction and severe tricuspid regurgitation. Contrast and transesophageal echocardiography revealed a patent foramen ovale with right-to-left shunt. After exclusion of other potential causes of the neurologic events, they were assumed to be the consequence of paradoxical embolism. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  16. Ischemia induced by coronary steal through a patent mammary artery side branch: a role for embolization.

    PubMed

    Moreno, Nuno; da Silva Castro, Alexandra; Pereira, Adriana; Silva, João Carlos; Almeida, Pedro Bernardo; Andrade, Aurora; Maciel, Maria Júlia; Pinto, Paula

    2013-06-01

    Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting. The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing. Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  17. Hypersensitivity to aspirin and urgent percutaneous coronary intervention: A therapeutic challenge.

    PubMed

    Duarte, Tatiana; Gonçalves, Sara; Sá, Catarina; Marinheiro, Rita; Rodrigues, Rita; Seixo, Filipe; Tomas, Elza; Caria, Rui

    2016-11-01

    Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs are common and five types of reactions have been defined. The prevalence of such reactions in patients with myocardial infarction is unclear, and so antiplatelet therapy in this population is a challenge. Various desensitization protocols have been developed but there are no specific guidelines for their use. The authors present the case of a patient with acute coronary syndrome and aspirin hypersensitivity referred for urgent coronary angiography. Aspirin desensitization therapy is safe and successful in many patients, but more randomized trials are needed to confirm its benefits in coronary artery disease patients. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Antiphospholipid syndrome and acute myocardial infarction: treatment with thrombectomy and abciximab.

    PubMed

    Martí, Vicens; Seixo, Filipe; Santaló, Miguel; Serra, Antonio

    2014-01-01

    Antiphospholipid syndrome (APS) is an autoimmune coagulation disorder that manifests clinically as venous and arterial thrombosis, and may affect any tissue or organ. Coronary artery involvement, however, is very rare. Case reports in the literature describing patients with coronary acute syndrome and APS treated with coronary angioplasty show conflicting results. We report an adult male patient with APS who presented with an acute myocardial infarction. Given the high risk of thrombosis in these patients, he was treated percutaneously with thrombectomy and abciximab. We review the few cases of coronary angioplasty in patients with APS reported to date. To our knowledge, this is the first case in which acute myocardial infarction due to thrombotic coronary occlusion was treated with thrombectomy and abciximab without stenting the artery. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  19. Brugada pattern in a patient medicated with lamotrigine.

    PubMed

    Rodrigues, Rita; Amador, Pedro; Rassi, Leandro; Seixo, Filipe; Parreira, Leonor; Fonseca, Nuno; Soares, Luís

    2013-10-01

    The authors report the case of a 52-year-old woman with depressive syndrome, treated with lamotrigine for about five months, who went to the emergency department for atypical precordial pain. The electrocardiogram (ECG) revealed a 2-mm downsloping ST-segment elevation and negative T waves in V1 and V2. Due to suspicion of ST-elevation acute coronary syndrome, cardiac catheterization was performed, which revealed normal coronary arteries. The initial ECG was suggestive of type 1 Brugada pattern, but subsequent serial ECGs were less typical. A flecainide test showed the same pattern. After discontinuation of lamotrigine reversal of the typical Brugada ECG pattern was observed. Although not currently contraindicated in Brugada syndrome, the antidepressant lamotrigine blocks sodium channels, which are usually inactivated in heart cell membranes in Brugada syndrome, and may be responsible for the expression of type 1 Brugada pattern. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. The vulnerable plaque: current concepts and future perspectives on coronary morphology, composition and wall stress imaging.

    PubMed

    Silva Marques, João; Pinto, Fausto J

    2014-02-01

    Cardiovascular imaging plays an important role in the identification and characterization of the vulnerable plaque. A major goal is the ability to identify individuals at risk of plaque rupture and developing an acute coronary syndrome. Early recognition of rupture-prone atherosclerotic plaques may lead to the development of pharmacologic and interventional strategies to reduce acute coronary events. We review state-of-the-art cardiovascular imaging for identification of the vulnerable plaque. There is ample evidence of a close relationship between plaque morphology and patient outcome, but molecular imaging can add significant information on tissue characterization, inflammation and subclinical thrombosis. Additionally, identifying arterial wall exposed to high shear stress may further identify rupture-prone arterial segments. These new modalities may help reduce the individual, social and economic burden of cardiovascular disease. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Evolutionary and Ecological Characterization of Mayaro Virus Strains Isolated during an Outbreak, Venezuela, 2010.

    PubMed

    Auguste, Albert J; Liria, Jonathan; Forrester, Naomi L; Giambalvo, Dileyvic; Moncada, Maria; Long, Kanya C; Morón, Dulce; de Manzione, Nuris; Tesh, Robert B; Halsey, Eric S; Kochel, Tadeusz J; Hernandez, Rosa; Navarro, Juan-Carlos; Weaver, Scott C

    2015-10-01

    In 2010, an outbreak of febrile illness with arthralgic manifestations was detected at La Estación village, Portuguesa State, Venezuela. The etiologic agent was determined to be Mayaro virus (MAYV), a reemerging South American alphavirus. A total of 77 cases was reported and 19 were confirmed as seropositive. MAYV was isolated from acute-phase serum samples from 6 symptomatic patients. We sequenced 27 complete genomes representing the full spectrum of MAYV genetic diversity, which facilitated detection of a new genotype, designated N. Phylogenetic analysis of genomic sequences indicated that etiologic strains from Venezuela belong to genotype D. Results indicate that MAYV is highly conserved genetically, showing ≈17% nucleotide divergence across all 3 genotypes and 4% among genotype D strains in the most variable genes. Coalescent analyses suggested genotypes D and L diverged ≈150 years ago and genotype diverged N ≈250 years ago. This virus commonly infects persons residing near enzootic transmission foci because of anthropogenic incursions.

  2. The value of cough peak flow measurements in the assessment of extubation or decannulation readiness.

    PubMed

    Winck, J C; LeBlanc, C; Soto, J L; Plano, F

    2015-01-01

    Insufficient cough strength has a major role in extubation and decannulation outcomes. Cough capacity can be easily evaluated by measuring flows during coughing. Values vary depending on whether cough flows are measured through the mouth or through a tracheostomy or endotracheal tube. It is important to standardize these measurements and start using them routinely in the extubation and decannulation processes. Values of cough peak flow >160 L/min measured at the mouth or a value of cough PEF >60 L/min measured at the endotracheal tube suggest successful decannulation or extubation. Copyright © 2014 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  3. Successful treatment of atelectasis with Dornase alpha in a patient with congenital muscular dystrophy.

    PubMed

    Crescimanno, G; Marrone, O

    2014-01-01

    A 28-year-old neuromuscular patient chronically treated with nocturnal noninvasive ventilation developed pulmonary lobar atelectasis and daytime hypoxemia. Twenty four-hour 5L/min oxygen was begun, while mechanical cough assist aids were applied for seven days. In the following three days, treatment with nebulized Dornase alpha (rhDNase) b.i.d. was tested, without any significant improvement. On 11 and 13th days rhDNase was instilled by flexible bronchoscopy. A rapid resolution of the atelectasis was observed with relief of hypoxemia, without significant side effects. On day 16 the patient was discharged without oxygen requirements. In non-intubated neuromuscular patients with atelectasis who do not respond successfully to non-invasive treatments intrabronchial instillation of rhDNase may safely help to improve airway clearance. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  4. Orbitozygomatic craniotomy in three pieces: tips and tricks.

    PubMed

    Chaddad Neto, Feres; Doria Netto, Hugo Leonardo; Campos Filho, José Maria; Reghin Neto, Mateus; Silva-Costa, Marcos Devanir; Oliveira, Evandro

    2016-03-01

    Didactically describe the orbitozygomatic craniotomy made in three pieces. This approach was performed, from 2002 to 2011, in 49 patients admitted at Beneficência Portuguesa of São Paulo Hospital. Twenty-seven patients had vascular lesions and twenty-two suffered for intracranial skull base tumors. The vascular lesions varied from cavernous angiomas inside the mesencephalum, high bifurcation basilar tip aneurysms, superior cerebellar arteries aneurysms and arteriovenous malformations in the interpeduncular cistern. Skull base tumors as meningiomas, interpeduncular hamartomas and third ventricle floor gliomas were among the neoplastic lesions approached. We had no permanent injuries and minimal transient complications had occurred. It is a descriptive text, organized in the sequence of the main stages in which such a craniotomy is performed, describing in details the technique in which this group of evolutionarily authors came to accomplish the task.

  5. [Treatment and follow up protocol in differentiated thyroid carcinomas of follicular origin].

    PubMed

    Rodrigues, Fernando; Limbert, Edward; Marques, Ana Paula; Santos, Ana Paula; Lopes, Carlos; Rodrigues, Elizabete; Borges, Fátima; Carrilho, Francisco; Castro, João Jácome de; Neto, João; Salgado, Lucília; Oliveira, Maria João

    2005-01-01

    Differentiated thyroid carcinoma of follicular origin (DTCFO), although not very frequent, has registered a raising incidence in the last decades. In the majority of the cases, DTCFO is a curable disease when treated and monitored by experienced, multidisciplinary teams. These factors contribute to an increasing number of DTCFO survivors requiring life-long monitoring, due to the possibility of occurrence of recurrences many years after the initial treatment. Several aspects of the treatment and management of these patients are still controversial. The present protocol represents the consensus of the members of the Grupo de Estudo da Tiróide of the Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. It aims to define guidelines, in agreement with the current state of the art and contemplating the necessary adaptations to local constrains, that ensure decreased mortality and protection of patients' quality of life, avoiding unnecessarily aggressive or ineffective treatments, optimizing the use of the available resources.

  6. A small great history of the sister Societies of Developmental Biology in Spain and Portugal.

    PubMed

    Palmeirim, Isabel; Aréchaga, Juan

    2009-01-01

    We revise the historical evolution of the societies devoted to Developmental Biology from the early activities of the Institut International dEmbryologie (IIE), founded in 1911, with particular emphasis on the more recent constitution of the Spanish Sociedad Española de Biología del Desarrollo (SEBD), founded in 1994, and the Portuguese Sociedade Portuguesa de Biologia do Desenvolvimento (SPBD), founded in 2006. We also describe the role played by The International Journal of Developmental Biology (IJDB) in the constitution of the SEBD and its projection and support to international Developmental Biology societies and individual researchers in the world, according to its mission to be a non-for-profit publication for scientists, by scientists.

  7. [Azithromycin as an adjuvant therapy in cryptogenic organizing pneumonia].

    PubMed

    Vaz, A P; Morais, A; Melo, N; Caetano Mota, P; Souto Moura, C; Amorim, A

    2011-01-01

    There are literature data about the immunomodulatory properties of some macrolides in cryptogenic organizing pneumonia (COP) as an alternative to corticosteroids in mild disease or as adjuvant to standard therapy. A sixty-year-old female, with a controlled intrinsic asthma, presented with COP and recurrent respiratory exacerbations despite corticosteroid and immunossupressant therapy. Azithromycin (500mg, on alternate days) as an adjuvant to steroids was then started, with clinical and functional improvement and regression of lung infiltrates. Withdrawal of steroids was possible in one year, without evidence of relapse in the next six months. Azithromycin was maintained (three times per week) with no documentation of adverse side effects. This clinical case reinforces the potential role of macrolides anti-inflammatory properties in COP as corticosteroids adjuvant therapy. Copyright © 2010 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  8. Intravenous leiomyomatosis: a rare cause of intracardiac mass.

    PubMed

    Cruz, Inês; João, Isabel; Stuart, Bruno; Iala, Mário; Bento, Luísa; Cotrim, Carlos; Nobre, Angelo; Pereira, Hélder

    2014-11-01

    Intravenous leiomyomatosis is an unusual clinical condition characterized by histologically benign smooth muscle lesions extending from the uterus into pelvic and systemic veins and, more rarely, into the right cardiac chambers. We report the case of a 45-year-old woman who presented with a three-week history of dyspnea on exertion, shortness of breath and fatigue. Echocardiography showed a large mobile mass in the right atrium prolapsing into the right ventricle and extending to the inferior vena cava. A computed tomography scan revealed a large mass extending from the right atrium to the inferior vena cava and through the systemic veins as far as the popliteal veins. A presumptive diagnosis of large thrombus was made; the correct diagnosis of intravenous leiomyomatosis with intracardiac involvement was obtained only after surgical resection and histologic examination. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Left ventricular noncompaction: A rare indication for pediatric heart transplantation.

    PubMed

    Magalhães, Mariana; Costa, Patrícia; Vaz, Maria Teresa; Pinheiro Torres, José; Areias, José Carlos

    2016-01-01

    Isolated left ventricular noncompaction is a rare congenital cardiomyopathy, characterized morphologically by a dilated left ventricle, prominent trabeculations and deep intertrabecular recesses in the ventricular myocardium, with no other structural heart disease. It is thought to be secondary to an arrest of normal myocardial compaction during fetal life. Clinically, the disease presents with heart failure, embolic events, arrhythmias or sudden death. Current diagnostic criteria are based on clinical and imaging data and two-dimensional and color Doppler echocardiography is the first-line exam. There is no specific therapy and treatment is aimed at associated comorbidities. Cases refractory to medical therapy may require heart transplantation. The authors describe a case of severe and refractory heart failure, which was the initial presentation of isolated left ventricular noncompaction in a previously healthy male child, who underwent successful heart transplantation. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Cardiac Anderson-Fabry disease: lessons from a 25-year-follow up.

    PubMed

    Brito, Dulce; Miltenberger-Miltenyi, Gabriel; Moldovan, Oana; Navarro, Carmen; Madeira, Hugo Costa

    2014-04-01

    Sarcomeric hypertrophic cardiomyopathy (HCM) is the most common genetic cause of unexplained left ventricular hypertrophy and has no specific treatment. Anderson-Fabry disease (AFD) is rare and usually multisystemic, but occasionally expresses clinically as a predominantly cardiac phenotype mimicking HCM. We describe an illustrative case of a patient followed regularly for 25 years with a diagnosis of familial HCM and no identified sarcomeric mutations. Next-generation sequencing analysis identified a novel pathogenic mutation in the GLA gene, leading to a diagnosis of previously unknown multisystemic AFD, with consequent implications for the patient's treatment and prognosis and familial screening. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. Interventional Algorithms for the Control of Coagulopathic Bleeding in Surgical, Trauma, and Postpartum Settings

    PubMed Central

    Rodrigues, Anabela; Gomes, Manuela; Carrilho, Alexandre; Nunes, António Robalo; Orfão, Rosário; Alves, Ângela; Aguiar, José; Campos, Manuel

    2014-01-01

    Several clinical settings are associated with specific coagulopathies that predispose to uncontrolled bleeding. With the growing concern about the need for optimizing transfusion practices and improving treatment of the bleeding patient, a group of 9 Portuguese specialists (Share Network Group) was created to discuss and develop algorithms for the clinical evaluation and control of coagulopathic bleeding in the following perioperative clinical settings: surgery, trauma, and postpartum hemorrhage. The 3 algorithms developed by the group were presented at the VIII National Congress of the Associação Portuguesa de Imuno-hemoterapia in October 2013. They aim to provide a structured approach for clinicians to rapidly diagnose the status of coagulopathy in order to achieve an earlier and more effective bleeding control, reduce transfusion requirements, and improve patient outcomes. The group highlights the importance of communication between different specialties involved in the care of bleeding patients in order to achieve better results. PMID:25424528

  12. LDL apheresis in the treatment of familial hypercholesterolemia: experience of Hospital Santo António, Porto.

    PubMed

    Palma, Isabel; Caldas, Ana Rita; Palma, Isabel Mangas; Queirós, José Alexandre; Madureira, Anselmo; Oliveira, José Carlos; Palma, Paulo; Correia, Carlos; Ramos, Maria Helena

    2015-03-01

    High plasma levels of low-density lipoprotein (LDL) cholesterol are a risk factor for the development of premature atherosclerosis. Direct adsorption of lipoproteins (DALI) is an apheresis technique by which LDL cholesterol is selectively removed from whole blood. The present study describes our experience with DALI LDL apheresis in severely hypercholesterolemic patients. Three hypercholesterolemic patients suffering from atherosclerotic complications were treated fortnightly by DALI apheresis, in a total of 308 sessions between December 2008 and January 2013. All patients were on the highest tolerated dose of statins and other lipid-lowering drugs. The sessions were essentially uneventful, adverse events being recorded in only 3.6% of them. A mean 63.3% acute reduction in LDL cholesterol was obtained. DALI apheresis proved to be a simple, safe and efficient method of lipid apheresis in hypercholesterolemic patients refractory to conservative lipid-lowering therapy. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Single coronary artery presenting as acute myocardial infarction.

    PubMed

    Jurado-Román, Alfonso; Sánchez-Pérez, Ignacio; Lozano-Ruíz-Poveda, Fernando; Pinilla-Echeverri, Natalia; López-Lluva, María T; Moreno-Arciniegas, Andrea; Marina-Breysse, Manuel; Piqueras-Flores, Jesús

    2017-02-01

    A single coronary artery is one of the most rarely seen coronary artery anomalies. In addition, the specific subtype (Lipton RII-A) that our patient presented is one of the least common, and its clinical presentation as myocardial infarction and cardiac arrest has not been described in the literature. The case shows that although it is essential to exclude a malignant interarterial course of the vessel, cardiac arrest is a possible clinical presentation produced by myocardial ischemia in the context of acute myocardial infarction and should be managed according to clinical practice guidelines. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Coronary artery aneurysm formation following implantation of a bioresorbable vascular scaffold for in-stent restenosis.

    PubMed

    García-Guimaraes, Marcos; Cuesta, Javier; Alvarado, Teresa; Rivero, Fernando; Bastante, Teresa; Benedicto, Amparo; Alfonso, Fernando

    2017-06-01

    Coronary artery aneurysm (CAA) formation is a rare complication of coronary intervention that may develop after implantation of bare-metal or drug-eluting stents. The etiology of this entity appears to be multifactorial and its prognosis is poorly understood, but it has been associated with an increased risk of stent thrombosis. To date few cases of CAAs related to bioresorbable vascular scaffold (BVS) implantation have been reported, and the development of CAA after BVS implantation for the treatment of in-stent restenosis (ISR) has not been previously described. Here we present two cases of CAA formation after BVS, which represent the first demonstration of CAA formation after the use of BVS for ISR. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Spontaneous coronary artery dissection: Still a lot to learn.

    PubMed

    Neves, David; Bento, Ângela; Fernandes, Renato; Patrício, Lino; Aguiar, José

    2017-01-01

    Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is an uncommon but probably underdetected pathological substrate for acute coronary syndrome. Clinical associations have been noted, like female gender and young age, but its pathophysiology is not yet fully understood. In this report we describe the case of a 50-year-old woman, without cardiovascular risk factors presenting with non-ST segment elevation myocardial infarction, in whom SCAD was diagnosed. Treatment was initially conservative but due to aggravation of the dissection she eventually underwent a complex percutaneous coronary intervention, requiring implantation of multiple stents, but with a good clinical outcome. The procedure was guided by optical coherence tomography (OCT). Carefully analyzing the combined pictures of OCT and angiography, the dissection appeared to be filled with a clear fluid, but not contrast. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Coexistence of dynamic mitral regurgitation and dynamic left ventricular dyssynchrony in a patient with repeated episodes of acute pulmonary edema: improvement with cardiac resynchronization therapy.

    PubMed

    Carvalho, Maria Salomé; Andrade, Maria João; Reis, Carla; Brito, João; Trabulo, Marisa; Mendes, Miguel

    2013-12-01

    A 69-year-old woman with idiopathic dilated cardiomyopathy and chronic heart failure experienced repeated hospital admissions for acute pulmonary edema with no recognizable precipitating factor. Worsening mitral regurgitation was triggered by exercise echocardiography and significant intraventricular dyssynchrony was elicited by low-dose dobutamine stress echocardiography. After cardiac resynchronization therapy she remained free of hospitalizations for 12 months. This case highlights the dynamic nature of both functional mitral regurgitation and left ventricular dyssynchrony and illustrates how in some patients stress echocardiography can help to clarify clinical scenarios and help with the challenging task of selecting patients who will benefit from cardiac resynchronization therapy. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  17. Mesalamine-induced myocarditis following diagnosis of Crohn's disease: a case report.

    PubMed

    Galvão Braga, Carlos; Martins, Juliana; Arantes, Carina; Ramos, Vítor; Vieira, Catarina; Salgado, Alberto; Magalhães, Sónia; Correia, Adelino

    2013-09-01

    Mesalamine is a common treatment for Crohn's disease, and can be rarely associated with myocarditis through a mechanism of drug hypersensitivity. We present the case of a 19-year-old male who developed chest pain two weeks after beginning mesalamine therapy. The electrocardiogram showed slight ST-segment elevation with upward concavity in the inferolateral leads; blood tests demonstrated elevated troponin I and the echocardiogram revealed moderately depressed left ventricular systolic function with global hypocontractility. Cardiac magnetic resonance imaging confirmed the diagnosis of myocarditis, revealing multiple areas of subepicardial fibrosis. The onset of symptoms after mesalamine, and improvement of chest pain, cardiac biomarkers and left ventricular systolic function after discontinuing the drug, suggest that our patient suffered from a rare drug-hypersensitivity reaction to mesalamine. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  18. Mitral valve aneurysm: A serious complication of aortic valve endocarditis.

    PubMed

    Sousa, Maria João; Alves, Vasco; Cabral, Sofia; Antunes, Nuno; Pereira, Luís Sousa; Oliveira, Filomena; Silveira, João; Torres, Severo

    2016-11-01

    Mitral valve aneurysms are rare and occur most commonly in association with aortic valve endocarditis. Transesophageal echocardiography is the most sensitive imaging modality for the diagnosis of this entity and its potential complications, such as leaflet rupture and mitral regurgitation, which mandate prompt surgical intervention. We present the case of a 70-year-old male patient with aortic valve endocarditis complicated with a ruptured aneurysm of the anterior mitral valve leaflet and associated severe mitral regurgitation, diagnosed by transesophageal echocardiography, with impressive images. We hypothesized that the aneurysm developed through direct extension of infection from the aortic valve or from a prolapsing aortic vegetation, with abscess formation and subsequent rupture and drainage. This case highlights the importance of appropriate imaging for early detection and timely surgical intervention (repair or replacement) to prevent fatal outcomes. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Primary cardiac lymphoma in a patient with concomitant renal cancer.

    PubMed

    Severino, Davide; Santos, Beatriz; Costa, Cátia; Durão, David; Alves, Miguel; Monteiro, Isabel; Pitta, Luz; Leal, Margarida

    2015-12-01

    Primary cardiac lymphoma is defined as non-Hodgkin lymphoma involving the heart and/or pericardium. It is a rare cancer that primarily affects the right heart and in particular the right atrium. By contrast, renal cell carcinoma is a relatively common cancer, which in rare circumstances can metastasize to the heart. It is now known that there is an association between non-Hodgkin lymphoma and renal cell carcinoma, although the underlying mechanisms are not fully understood. The authors present a case of primary cardiac non-Hodgkin lymphoma in a patient with concomitant renal cell carcinoma and explore the possible reasons for this association. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. High left ventricular outflow tract gradient: Aortic stenosis, obstructive hypertrophic cardiomyopathy or both?

    PubMed

    Almeida, Inês; Caetano, Francisca; Trigo, Joana; Mota, Paula; Marques, António Leitão

    2015-05-01

    The authors report the case of a patient diagnosed with both hypertrophic cardiomyopathy and aortic stenosis. Due to clinical deterioration, additional investigation was performed, and a high left ventricular outflow tract gradient was identified. Correct identification of the condition causing the symptoms was challenging, and involved several imaging techniques, the contribution of transesophageal echocardiography being crucial. The final diagnosis of severe aortic stenosis led to successful valve replacement surgery. The presence of these two conditions in the same patient has been documented, although it is uncommon. This association poses particular diagnostic and therapeutic challenges, which are discussed in this paper. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. [Bisphosphonate-associated osteonecrosis of the jaws in lung cancer patients].

    PubMed

    Neves, Inês; Morais, António; Magalhães, Adriana

    2013-01-01

    Osteonecrosis of the jaw (ONJ) can occur as a complication of bisphosphonate therapy. This condition has been described in cancer patients and its development has been associated with prolonged exposure to high doses of bisphosphonates. Bad dental hygiene, a history of prosthesis or dental extraction, chemotherapy, corticosteroids, and radiation therapy of the head and neck are risk factors reported. In the initial stages it may be asymptomatic, but the patient subsequently develops severe pain and progressive exposed bone. The authors describe three cases of ONJ in lung cancer patients after prolonged exposure to bisphosphonates and there were known risk factors. ONJ can seriously affect the quality of life of cancer patients. An early diagnosis may reduce or avoid the consequences of progressive bone lesion. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  2. Effects of asthma in nutritional status in children: A systematic review.

    PubMed

    da Cunha, Daniele Andrade; da Silva, Hilton Justino; de Araújo Pernambuco, Leandro; de Moraes, Klyvia Juliana Rocha; do Prado, Isabella Jerônimo; de Andrade, Gutemberg Moura; da Cunha, Renata Andrade; Nascimento, Gerlane Karla Bezerra Oliveira; Régis, Renata Milena Freire Lima; de Castro, Celia Maria Machado Barbosa

    2010-01-01

    Asthma is a chronic inflammatory disease of high prevalence, considered a public health problem and is thought to be one cause of low birth weight and growth retardation. The purpose of this article was to review in literature the effects of asthma on the nutritional status in children. A systematic review was made by searching for articles in PubMed, SciELO and LILACS databases. Review articles, studies with adults or research that did not evaluate the effects of asthma in children were excluded. Hence original articles in humans were included. In the systematic review we found 901 articles in MEDLINE (1966-1996), 47 in LILACS and SciELO in the 16 Brazil, totaling 964 articles. Of these, 17 articles were selected. Evidence that asthma interferes in nutritional status can not be proven in this study. Rev Port Pneumol 2010; XVI (4): 617-626. © 2010 Sociedade Portuguesa de Pneumologia/SPP.

  3. Role of maximal inspiratory presure in the evaluetion of respiratory muscle strength in asthmatics - Systematic review.

    PubMed

    Cavalcante Marcelino, Alessandra M F; da Silva, Hilton Justino

    2010-01-01

    Asthma is a chronic illness of the airways that can reduce respiratory muscle strength due to the resulting hyperinflation or treatment with corticosteroids. One of the ways to evaluate this respiratory muscular weakness is the Maximal Inspiratory Pressure (PImax). A systematic review of the databases PUBMED/MEDLINE, LILACS and SCIELO was carried through, using the key words: Asthma, respiratory muscle and muscle strength. Fifty were found and six articles that evaluated the PImax in asthmatics, from these, thirty were excluded, making a total of twenty six articles. Through the present revision we show the effectiveness of PImax in evaluating respiratory muscle strength in asthmatics. More studies are needed, however, fot better understanding of the asthmatic individual. Rev Port Pneumol 2010; XVI (3): 463-470. © 2010 Sociedade Portuguesa de Pneumologia/SPP.

  4. Heart transplant coronary artery disease: Multimodality approach in percutaneous intervention.

    PubMed

    Leite, Luís; Matos, Vítor; Gonçalves, Lino; Silva Marques, João; Jorge, Elisabete; Calisto, João; Antunes, Manuel; Pego, Mariano

    2016-06-01

    Coronary artery disease is the most important cause of late morbidity and mortality after heart transplantation. It is usually an immunologic phenomenon termed cardiac allograft vasculopathy, but can also be the result of donor-transmitted atherosclerosis. Routine surveillance by coronary angiography should be complemented by intracoronary imaging, in order to determine the nature of the coronary lesions, and also by assessment of their functional significance to guide the decision whether to perform percutaneous coronary intervention. We report a case of coronary angiography at five-year follow-up after transplantation, using optical coherence tomography and fractional flow reserve to assess and optimize treatment of coronary disease in this challenging population. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  5. Venezuelan haemorrhagic fever.

    PubMed

    Salas, R; de Manzione, N; Tesh, R B; Rico-Hesse, R; Shope, R E; Betancourt, A; Godoy, O; Bruzual, R; Pacheco, M E; Ramos, B

    1991-10-26

    An outbreak of severe haemorrhagic illness began in the municipality of Guanarito, Portuguesa State, Venezuela, in September, 1989. Subsequent detailed study of 15 cases confirmed the presence of a new viral disease, designated Venezuelan haemorrhagic fever. Characteristic features are fever, toxicity, headache, arthralgia, diarrhoea, conjunctivitis, pharyngitis, leucopenia, thrombocytopenia, and haemorrhagic manifestations. Other features include facial oedema, cervical lymphadenopathy, nausea/vomiting, cough, chest or abdominal pain, and convulsions. The patients ranged in age from 6 to 54 years; all were residents of rural areas in central Venezuela, and 9 died. Infection with Guanarito virus, a newly recognised arenavirus, was shown by direct culture or by serological confirmation in all cases. Epidemiological studies suggest that the disease is endemic in some rural areas of central Venezuela and that it is rodent-borne. Venezuelan haemorrhagic fever has many similarities to Lassa fever and to the arenavirus haemorrhagic fevers that occur in Argentina and Bolivia.

  6. Aortic intramural hematoma: an unpredictable evolution.

    PubMed

    Ponte, Marta; Dias Ferreira, Nuno; Bettencourt, Nuno; Caeiro, Daniel; Fonseca, Marlene; Albuquerque, Aníbal; Vouga, Luís; Gama, Vasco

    2014-01-01

    Aortic intramural hematoma (IMH) is an acute aortic syndrome characterized by bleeding into the media of the aortic wall without intimal disruption or the classic flap formation. Its natural history is variable and still poorly understood, so strategies for therapeutic management are not fully established. In some cases there is partial or complete regression of the hematoma under medical treatment, but most progress to dissection, aneurysmal dilatation or aortic rupture. The authors present the case of a 44-year-old hypertensive male patient admitted with a diagnosis of IMH of the descending aorta. Despite initial symptom resolution and optimal medical therapy, the IMH evolved to a pseudoaneurysm, which was successfully treated by an endovascular approach. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. Prosthetic mitral valve thrombosis in pregnancy: from thrombolysis to anticoagulation.

    PubMed

    Cardoso, Gonçalo; Aguiar, Carlos; Andrade, Maria João; Patrício, Lino; Freire, Isabel; Serrano, Fátima; Anjos, Rui; Mendes, Miguel

    2015-01-01

    Pregnant women with mechanical prosthetic heart valves are at increased risk for valve thrombosis. Management decisions for this life-threatening complication are complex. Open-heart surgery has a very high risk of maternal mortality and fetal loss. Bleeding and embolic risks associated with thrombolytic agents, the limited efficacy of thrombolysis in certain subgroups, and a lack of experience in the setting of pregnancy raise important concerns. We report a case of mitral prosthetic valve thrombosis in early pregnancy, which was successfully treated with streptokinase. Ten years later, the same patient had an uneventful pregnancy, throughout which acenocoumarol was maintained. With this case we review the prevention (with oral anticoagulant therapy) and treatment of prosthetic valve thrombosis during pregnancy, which is important for both obstetrician and cardiologist. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Murmur from a bullet: Old lesion, new treatment.

    PubMed

    Neves, David; Bettencourt, Nuno; Braga, Pedro; Gama, Vasco

    2015-06-01

    Aortic disease can be highly variable in terms of lesion morphology, clinical presentation and etiology. We present the case of a young man who suffered a gunshot injury at the age of 12, resulting in paraplegia. Later a murmur was detected and at age 25 a pseudoaneurysm was diagnosed, with fistulization to the left pulmonary artery. Given his good functional status, he was initially managed by a conservative strategy, with regular follow-up. At age 35 left ventricular dilatation was observed with tachycardia and systolic dysfunction, and he was referred for transcatheter aortic valve replacement. Currently, at age 41, he is well in cardiovascular terms, with a good procedural result and professionally active. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Functional assessment of coronary artery disease by intravascular ultrasound and computational fluid dynamics simulation.

    PubMed

    Carrizo, Sebastián; Xie, Xinzhou; Peinado-Peinado, Rafael; Sánchez-Recalde, Angel; Jiménez-Valero, Santiago; Galeote-Garcia, Guillermo; Moreno, Raúl

    2014-10-01

    Clinical trials have shown that functional assessment of coronary stenosis by fractional flow reserve (FFR) improves clinical outcomes. Intravascular ultrasound (IVUS) complements conventional angiography, and is a powerful tool to assess atherosclerotic plaques and to guide percutaneous coronary intervention (PCI). Computational fluid dynamics (CFD) simulation represents a novel method for the functional assessment of coronary flow. A CFD simulation can be calculated from the data normally acquired by IVUS images. A case of coronary heart disease studied with FFR and IVUS, before and after PCI, is presented. A three-dimensional model was constructed based on IVUS images, to which CFD was applied. A discussion of the literature concerning the clinical utility of CFD simulation is provided. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. [A rare case of two mechanisms of prosthetic valve dysfunction in the same patient].

    PubMed

    Cardoso, Gonçalo; Trabulo, Marisa; Andrade, Maria João; Ribeiras, Regina; Rodrigues, Rui; Neves, José Pedro; Queiróz e Melo, João; Mendes, Miguel

    2013-12-01

    Prosthetic valve dysfunction is a significant clinical event. Determining its etiological mechanism and severity can be difficult. The authors present the case of a 50-year-old man, with two mechanical valve prostheses in aortic and mitral positions, hospitalized for decompensated heart failure. He had a long history of rheumatic multivalvular disease and had undergone three heart surgeries. On admission, investigation led to a diagnosis of severe dysfunction of both mechanical prostheses with different etiologies and mechanisms: pannus formation in the prosthetic aortic valve and intermittent dysfunction of the mitral prosthesis due to interference of a ruptured chorda tendinea in closure of the disks. The patient was reoperated, leading to significant improvement in functional class. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. Prevention of ventilator-associated pneumonia.

    PubMed

    Oliveira, J; Zagalo, C; Cavaco-Silva, P

    2014-01-01

    Invasive mechanical ventilation (IMV) represents a risk factor for the development of ventilator-associated pneumonia (VAP), which develops at least 48h after admission in patients ventilated through tracheostomy or endotracheal intubation. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving IMV. It contributes to an increase in hospital mortality, duration of MV and ICU and length of hospital stay. Therefore, it worsens the condition of the critical patient and increases the total cost of hospitalization. The introduction of preventive measures has become imperative, to ensure control and to reduce the incidence of VAP. Preventive measures focus on modifiable risk factors, mediated by non-pharmacological and pharmacological evidence based strategies recommended by guidelines. These measures are intended to reduce the risk associated with endotracheal intubation and to prevent microaspiration of pathogens to the lower airways. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  12. Perivalvular pannus and valve thrombosis: two concurrent mechanisms of mechanical valve prosthesis dysfunction.

    PubMed

    Arnáiz-García, María Elena; González-Santos, Jose María; Bueno-Codoñer, María E; López-Rodríguez, Javier; Dalmau-Sorlí, María José; Arévalo-Abascal, Adolfo; Arribas-Jiménez, Antonio; Diego-Nieto, Alejandro; Rodríguez-Collado, Javier; Rodríguez-López, Jose María

    2015-02-01

    A 78-year-old woman was admitted to our institution with progressive dyspnea. She had previously been diagnosed with rheumatic heart disease and had undergone cardiac surgery for mechanical mitral valve replacement ten years previously. Transesophageal echocardiography revealed blockage of the mechanical prosthesis and the patient was scheduled for surgery, in which a thrombus was removed from the left atrial appendage. A partial thrombosis of the mechanical prosthesis and circumferential pannus overgrowth were concomitantly detected. Prosthetic heart valve blockage is a rare but life-threatening complication, the main causes of which are thrombosis and pannus formation. The two conditions are different but both are usually misdiagnosed. Two concurrent mechanisms of prosthesis blockage were found in this patient. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Cost-effectiveness of ambulatory blood pressure monitoring in the management of hypertension.

    PubMed

    Costa, Diogo; Peixoto Lima, Ricardo

    2017-02-01

    The prevalence of hypertension in Portugal is between 29.1% and 42.2%. International studies show that 13% of individuals have masked hypertension and 13% of diagnoses based on office blood pressure measurements are in fact white coat hypertension. More sensitive and specific blood pressure measuring methods could avoid costs associated with misdiagnosis. The aim of this study was to review the cost-effectiveness of ambulatory blood pressure monitoring (ABPM) compared to other methods in the management of hypertension. We performed a literature search in CMA Infobase, Guidelines Finder, National Guideline Clearinghouse, Bandolier, BMJ Clinical Evidence, the Cochrane Library, DARE, Medline, the Trip Database, SUMSearch and Índex das Revistas Médicas Portuguesas. We researched articles published between January 2005 and August 2015 in Portuguese, English and Spanish, using the MeSH terms "Hypertension", "Blood Pressure Monitoring, Ambulatory" and "Cost-Benefit Analysis" and the Portuguese search terms "Hipertensão", "Monitorização Ambulatorial da Pressão Arterial" and "Análise Custo-Benefício". Levels of evidence and grades of recommendation were attributed according to the Oxford Centre for Evidence-Based Medicine scale. Five hundred and twenty-five articles were identified. We included five original studies and one clinical practice guideline. All of them state that ABPM is the most cost-effective method. Two report better blood pressure control, and a Portuguese study revealed a saving of 23%. The evidence shows that ABPM is cost-effective, avoiding iatrogenic effects and reducing expenditure on treatment (grade of recommendation B). The included studies provide a solid basis, but further evidence of reproducibility is needed in research that is not based mainly on analytical models. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Evaluation of the Psychometric Properties of NOC Outcomes "Anxiety Level" and "Anxiety Self-Control" in a Portuguese Outpatient Sample.

    PubMed

    Sampaio, Francisco Miguel Correia; Araújo, Odete Sofia Silva Lomba; Sequeira, Carlos Alberto da Cruz; Lluch Canut, María Teresa; Martins, Teresa

    2017-01-25

    To adopt the language and to evaluate the psychometric properties of "Anxiety level" and "Anxiety self-control" NOC outcomes in Portuguese adult patients. Methodological design. The final European Portuguese version of the NOC outcome "Anxiety level," composed by 16 indicators, proved excellent internal consistency. Exploratory factor analysis (EFA) was forced to three factors. The NOC outcome "Anxiety self-control," composed of nine indicators, demonstrated a questionable internal consistency. EFA was forced to two factors. European Portuguese versions of the studied NOC outcomes proved to be tools with acceptable psychometric properties for evaluating anxiety in Portuguese patients. This study contributed to the development of NOC language and to the enrichment of nursing's body of knowledge. Adaptar a linguagem e avaliar as propriedades psicométricas dos resultados NOC "Nível de ansiedade" e "Autocontrolo da ansiedade" em utentes portugueses adultos. MÉTODOS: Estudo metodológico. A versão portuguesa do resultado NOC "Nível de ansiedade", composta por 16 indicadores, apresentou uma excelente consistência interna. A análise fatorial exploratória (AFE) foi forçada a três dimensões. O resultado NOC "Autocontrolo da ansiedade", composto por nove indicadores, apresentou uma consistência interna questionável. A AFE foi forçada a duas dimensões. CONCLUSÕES: As versões portuguesas dos resultados NOC estudados são instrumentos com propriedades psicométricas aceitáveis para avaliar a ansiedade em utentes portugueses. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Este estudo contribuiu para o desenvolvimento da linguagem NOC e para enriquecer o corpo de conhecimento de Enfermagem. © 2017 NANDA International, Inc.

  15. [End of the borders? Undocumented migration from Mexico to the United States].

    PubMed

    Castillo, D

    1993-01-01

    This is an analysis of trends in illegal labor migration between Mexico and the United States from 1924 to 1986. Data are primarily from the 1984 Encuesta a Trabajadores Indocumentados Devueltos de Estados Unidos, supplemented by more recent studies.

  16. 77 FR 58208 - Airport Privatization Pilot Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-19

    ... Rico. Spanish Translation Department de Estado de Puerto Rico, Centro nico de Servicio, Edificio... decision. Spanish/ English translation will be made available at the meeting. Sign and oral interpretation...

  17. Overactive Thyroid: What You Need to Know

    MedlinePlus

    ... o problemas de tiroides, como bocio • tiene una historia familiar de enfermedad tiroidea • tiene anemia perniciosa, una ... de los Estados Unidos. Esta publicación no tiene derechos de autor. El NIDDK otorga su permiso a ...

  18. Pesticide Avoidance Behavior in Anopheles albimanus, a Malaria Vectorin Central and South America

    DTIC Science & Technology

    1995-07-11

    tropical medicine: an introduction. Trans. R. Soc. Trop. 46: 216-226. Calderon, G.R. 1988. Estado actual de los plaguicidas en EI Salvador. PAHO...pp. Carrillo, H.F. 1988. Empleo de plaguicidas para fines agricoJas Estados Unidos Mexicanos, 1984-1988. PAHO Regional Conference. 13 pp. Caspari...J., Ferrer, A . & Montenegro. L. 1988. Diagnostico sobre usc de plaguicidas poT productores nacionales. PAHO Regional Conference. 22 pp. Ewing, A.W

  19. Information Operations, an Evolutionary Step for the Mexican Armed Forces

    DTIC Science & Technology

    2007-12-01

    Institucional (PRI). It became Mexico’s "official" party which operated as a "true hegemonic party in the sense that, having itself achieved a de facto...8217expressing public 25 In 2000, the Partido Revolucionario Institucional (PRI) at the end of President...strategies of the National Development Plan Hacia un Estado Comunitario 2002- 2006 and its successor, Estado Comunitario: Desarrollo para Todos 2006-2010

  20. A Study of the Long Term Effect of the North American Free Trade Agreement on the U.S. Investment in Mexico and the Resulting Impact on U.S. Exports to Mexico

    DTIC Science & Technology

    1994-05-19

    variables.2 They also use dummy variables for whether or not the country speaks English, is a Latin American nation, or is a member of the European...International Rate Financial Statistics Monetary Fund Mexico’s Tax on Segundo Informe de Estados Unidos Production Gobierno (1990) Mexicanos Mexico’s...Tariff "Mexico-Country National Trade Rate Marketing Plan" Data Bank (various years) Value Added Segundo Informe de Estados Unidos Gobierno Mexicanos

  1. [Factors related with post-surgical complications in elderly patients with glioblastoma multiforme].

    PubMed

    Martin-Risco, M; Rodrigo-Paradells, V; Olivera-Gonzalez, S; Del Rio-Perez, C M; Bances-Florez, L; Calatayud-Perez, J B; Villagrasa-Compaired, F J

    2017-02-16

    Introduccion. El glioblastoma multiforme es el tumor maligno mas frecuente del sistema nervioso central, y su incidencia es del 80% en los mayores de 50 años. En los ultimos tiempos se ha producido un aumento en la esperanza de vida de la poblacion, y el analisis de las complicaciones posquirurgicas en pacientes de edad avanzada resulta de gran relevancia para una correcta indicacion quirurgica. Objetivo. Analizar factores relacionados con las complicaciones posquirurgicas en pacientes de edad avanzada. Pacientes y metodos. Se analizan retrospectivamente 88 pacientes diagnosticados de glioblastoma multiforme entre 31 y 78 años. Las variables estudiadas son: antecedentes personales, edad, estado funcional, estado preanestesico, caracteristicas tumorales, tipo de cirugia y complicaciones posquirurgicas. Resultados. Se observa una influencia de la edad en las complicaciones quirurgicas locales (p = 0,006) y sistemicas (p = 0,034) y en la escala de Clavien-Dindo (p = 0,001). Las personas con peor estado funcional y riesgo cardiovascular presentaron mas complicaciones sistemicas (p = 0,006 y 0,044) y peor graduacion en dicha escala (p = 0,024 y 0,025). Asimismo, hallamos mas complicaciones locales en las cirugias de exeresis que en las biopsias (p = 0,027). El estado preanestesico y los tratamientos antihemostaticos no se relacionaron con dichos eventos. Conclusiones. Los pacientes mayores de 65 años presentan una mayor incidencia de antecedentes patologicos y peor estado funcional prequirurgico. La edad, el riesgo cardiovascular, el estado funcional y el tipo de cirugia han aumentado de manera significativa las complicaciones posquirurgicas.

  2. [Prevalence of malnutrition in Spanish institutionalized older people: a multicentric nationwide analysis].

    PubMed

    Vaca Bermejo, Raúl; Ancizu García, Iciar; Moya Galera, David; de las Heras Rodríguez, Mónica; Pascual Torramadé, Josep

    2014-10-06

    Introducción: Un estado nutricional deficitario tiene importantes consecuencias en la salud de los colectivos en situación de especial vulnerabilidad, como las personas con enfermedades crónicas o personas mayores en situación de dependencia. Objetivo: Conocer el estado nutricional al ingreso de usuarios en centros SARquavitae. Material y Método: Se estudió el estado de salud, cognitivo y funcional de las personas que ingresaron durante el año 2012 en algún centro de la compañía. El estado nutricional fue evaluado mediante la versión corta del Mini Nutritional Assessment. Asimismo, se realizó un análisis para conocer las variables con mayor influencia en el estado nutricional de la muestra objeto de estudio. Resultados: Se analizaron las historias clínicas de 4.297 ingresos. La edad media fue de 82,08 años. Un 66,1% eran mujeres con una alta pluripatología. Al ingreso, un 30,4% de la muestra se encuentra en situación de desnutrición y un 49,4% en riesgo de desnutrición. Se observa una mayor prevalencia de desnutrición en mujeres, en aquellas personas que son derivadas por un hospital de agudos o por sus consultas externas, con peor estado funcional y cognitivo y en aquellas con procesos patológicos como demencia, enfermedades cerebrovasculares o disfagia. Conclusiones: Los resultados de este estudio ponen de manifiesto la alta complejidad clínica de las personas que ingresan en los centros residenciales estudiados, evidenciando la necesidad de realizar valoraciones integrales que permitan establecer planes de cuidados específicos para los perfiles atendidos.

  3. Worldwide Crisis Alerting Network, Phase II. Task 2. Identification of Existing Communications Systems,

    DTIC Science & Technology

    1980-04-01

    Unis, le service VHF/UHF est assurE a.-dessus du niveau de vol 180. Realmento, sobre todo el territorio de Estados Unidos se proporcions ...:ertura VHF...Unis, It service VHF/UHF est assurf au-dessus du niveau de vol 180. Realmente, sobrn todo *I territorio de Estados Unidos se proporciona cobert.ra...U.S. Sur tout le territoire des Etats-Unis, le service VHF/UHF est assurf au-dest.s du niveau de vol 180. Realhente. sobre todo el territorio de

  4. Honduran-U.S. Relations

    DTIC Science & Technology

    2009-08-04

    Miami Herald, July 16, 2009; “Informe Preliminar: Violaciones a Derechos Humanos en el Marco del Golpe de Estado en Honduras,” Comité de Familiares de...Detenidos Desaparecidos en Honduras (CONFADEH), July 15, 2009; “Reporte de Violaciones a Derechos Humanos Después del Golpe de Estado Político-Militar...del 28 de Junio de 2009,” Centro de Investigacion y Promocion de los Derechos Humanos (CIPRODEH), July 17, 2009. 31 For more on the U.S. response

  5. Symptoms, location and prognosis of pulmonary embolism.

    PubMed

    García-Sanz, M T; Pena-Álvarez, C; López-Landeiro, P; Bermo-Domínguez, A; Fontúrbel, T; González-Barcala, F J

    2014-01-01

    Pulmonary embolism (PE) is a common disease with variable symptoms and high overall mortality. The clinical relevance of the extent of PE is still debatable, and the role of anticoagulation in patients with subsegmental involvement has been contested. Our objective is to describe the clinical details of patients with PE in our hospital and to analyze their prognosis based on the extent of the disease. Retrospective study of 313 patients diagnosed with PE by chest computed tomography (CT) scan at the Hospital Complex of Pontevedra in Spain for six years. Predictors of mortality were determined by multivariate analysis. Women accounted for 56% of patients, and patient median age was 70 years (interquartile range 53-78 years). Subsegmental PE accounted for 7% of all cases; these patients were younger and had lower comorbidity; they reported chest pain more often, performed better in blood gas analysis and none of them had proximal deep vein thrombosis (DVT). Patients with subsegmental PE had a higher survival rate. Factors independently associated with mortality were cancer diagnosis and higher comorbidity. Patients with subsegmental PE clinically differ from those with more proximal PE. Underlying diseases have more influence on the prognosis than the extent of the disease. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  6. [Prevention and treatment of venous thromboembolism: the place of new oral anticoagulants].

    PubMed

    Reis, Abílio

    2012-04-01

    Venous thromboembolism (VTE) is still an important problem of Public Health, due to its impact in terms of morbidity, mortality, resource allocation and associated costs. In the prevention and treatment of VTE, pharmacological therapy is well defined and efficacious but has some inconveniences that leave space for improvement. Several new oral anticoagulants are being developed and tested for the prevention and treatment of VTE. The better studied are the selective Factor Xa inhibitors apixaban, rivaroxaban and edoxaban, and the thrombin antagonist dabigatran. They all are orally administrated, don't have important interactions with food or other drugs, have a convenient fixed-dose regimen and a predictable action, and dispense routine monitoring of their anticoagulant effect. The major part of them has phase III studies concluded and published. Some of them are already approved by de European Medicines Agency (EMA) and the Food and Drug Administration (FDA) and recommended by the international guidelines. Rivaroxaban is approved by the EMA for the treatment of deep venous thrombosis (DVT) and for the prevention of recurrences of DVT and pulmonary embolism. In this article the available evidences are reviewed, the place of the new oral anticoagulants is discussed and future perspectives regarding the prevention and treatment of VTE are outlined. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. The value of isovolumic acceleration for the assessment of right ventricular function in acute pulmonary embolism.

    PubMed

    Selcuk, Murat; Sayar, Nurten; Demir, Serafettin; Rodi Tosua, Aydın; Aslan, Vedat

    2014-10-01

    The aim of this study was to assess the value of tricuspid annulus myocardial isovolumic acceleration (IVA) in the assessment of right ventricular function in patients with acute pulmonary embolism (PE). Fifteen patients (mean age 60.6±11.3 years) with acute PE were enrolled and a control group was formed of 15 patients with a similar mean age (60.3±11.5). Patients who were diagnosed with acute PE by thoracic computed tomography angiography underwent transthoracic echocardiography at the time of diagnosis and at one month after diagnosis. In the control group IVA was 2.8±0.2 m/s(2), while in the acute PE group, it was 2.0±0.1 m/s(2) at the time of diagnosis and 2.9±0.1 m/s(2) at the end of the first month. When IVA values of acute PE patients at the end of the first month were compared with their initial values and those of the control group, they had normalized (control and acute PE p<0.0001; control and PE at one-month follow-up p=0.983). In our study, IVA was shown to be a reliable marker of right ventricular systolic function in patients with acute PE. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Association of types of dyspnea including 'bendopnea' with cardiopulmonary disease in primary care.

    PubMed

    Martínez Cerón, Diana María; Garcia Rosa, Maria Luiza; Lagoeiro Jorge, Antônio Jose; de Andrade Martins, Wolney; Tinoco Mesquita, Evandro; Di Calafriori Freire, Monica; da Silva Correia, Dayse Mary; Kang, Hye Chung

    2017-03-01

    Dyspnea is the symptom most commonly reported by patients with heart failure (HF) and/or pulmonary disease, the obese and the elderly. Recently 'bendopnea' (shortness of breath when bending forward) has been described in patients with HF. To determine the association of exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea and bendopnea with chronic disease, especially heart failure, and their phenotypes in primary care. This cross-sectional study included 633 individuals aged between 45 and 99 years enrolled in a primary care program in Niteroi, Brazil. Participants underwent clinical assessment and laboratory tests and completed a questionnaire, all on the same day. Paroxysmal nocturnal dyspnea and bendopnea were associated with HF (unadjusted OR 2.42, 95% CI 1.10-5.29 and OR 2.59, 95% CI 1.52-4.44, respectively). In multivariate models, chronic obstructive pulmonary disease, coronary heart disease and myocardial infarction were not associated with bendopnea. Bendopnea was the only type of dyspnea not linked to respiratory disease or coronary heart disease. Even after adjusting for depression and body mass index, the association remained with HF with or without preserved ejection fraction, and bendopnea thus appears to be a promising symptom to differentiate HF from the other two disease groups. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Type 4 cardiorenal syndrome.

    PubMed

    Pinheiro da Silva, Ana Luísa; Vaz da Silva, Manuel Joaquim

    2016-11-01

    The Acute Dialysis Quality Initiative consensus conference proposed a classification of cardiorenal syndrome (CRS), aiming for a better delineation of each subtype. Although the exact pathophysiology of type 4 CRS is not completely understood, the mechanisms involved are probably multifactorial. There is growing evidence that oxidative stress is a major connector in the development and progression of type 4 CRS. Giving its complexity, poor prognosis and increasing incidence, type 4 CRS is becoming a significant public health problem. Patients with chronic kidney disease are particularly predisposed to cardiac dysfunction, due to the high prevalence of traditional cardiovascular risk factors in this population, but the contribution of risk factors specific to chronic kidney disease should also be taken into account. Much remains to be elucidated about type 4 CRS: despite progress over the last decade, there are still significant questions regarding its pathophysiology and there is as yet no specific therapy. A better understanding of the mechanisms involved may provide potential targets for intervention. The present review will provide a brief description of the definition, epidemiology, diagnosis, prognosis, biomarkers and management strategies of type 4 CRS, and the pathophysiological mechanisms and risk factors presumably involved in its development will be particularly highlighted. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia.

    PubMed

    Sousa, Pedro A; Pereira, Salomé; Candeias, Rui; de Jesus, Ilídio

    2014-03-01

    Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin, it is the 12-lead surface electrocardiogram that usually enables this differentiation. Since 1978, various electrocardiographic criteria have been proposed for the differential diagnosis of wide complex tachycardias, particularly the presence of atrioventricular dissociation, and the axis, duration and morphology of QRS complexes. Despite the wide variety of criteria, diagnosis is still often difficult, and errors can have serious consequences. To reduce such errors, several differential diagnosis algorithms have been proposed since 1991. However, in a small percentage of wide QRS tachycardias the diagnosis remains uncertain and in these the wisest decision is to treat them as ventricular tachycardias. The authors' objective was to review the main electrocardiographic criteria and differential diagnosis algorithms of wide QRS tachycardia. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. The prevalence of oral anticoagulation in patients with atrial fibrillation in Portugal: Systematic review and meta-analysis of observational studies.

    PubMed

    Caldeira, Daniel; Barra, Márcio; David, Cláudio; Costa, João; Ferreira, Joaquim J; Pinto, Fausto J

    2014-09-01

    Oral anticoagulation (OAC) is an effective treatment in the prevention of thromboembolic events in patients with atrial fibrillation (AF). The aim of this review was to estimate the prevalence of OAC therapy in patients with AF in Portugal. MEDLINE, the Index of Portuguese Medical Journals and SIBUL (the Bibliographic Catalog of the Integrated Library System of the University of Lisbon) were searched for Portuguese observational studies reporting the proportion of anticoagulated patients with AF. The pooled estimated prevalence of anticoagulated patients and respective 95% confidence interval (CI) were determined by means of a meta-analysis. Seven studies were included for analysis, of which four were conducted in a hospital environment and three in the general community. These studies enrolled a total of 891 patients with AF. The pooled estimated prevalence of anticoagulated patients was 40% (95% CI: 32-48%). The prevalence of OAC in Portuguese AF patients is low. There is a need to promote change in OAC prescribing habits for AF patients in Portugal, in accordance with international guidelines. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. Association between cardiovascular disease and socioeconomic level in Portugal.

    PubMed

    Ribeiro, Sónia; Furtado, Cláudia; Pereira, João

    2013-11-01

    Cardiovascular disease is the leading cause of morbidity, mortality and disability in Portugal. Socioeconomic level is known to influence health status but there is scant evidence on socioeconomic inequalities in cardiovascular disease in Portugal. To analyze the distribution of cardiovascular disease in the Portuguese population according to socioeconomic status. We conducted a cross-sectional study using data from the fourth National Health Survey on a representative sample of the Portuguese population. Socioeconomic inequalities in cardiovascular disease, risk factors and number of medical visits were analyzed using odds ratios according to socioeconomic status (household equivalent income) in the adult population (35-74 years). Comparisons focused on the top and bottom 50% and 10% of household income distribution. Of the 21 807 individuals included, 53.3% were female, and mean age was 54 ± 11 years. Cardiovascular disease, stroke, ischemic heart disease, hypertension, diabetes, obesity and physical inactivity were associated with lower socioeconomic status, while smoking was associated with higher status; number of medical visits and psychological distress showed no association. When present, inequality was greater at the extremes of income distribution. The results reveal an association between morbidity, lifestyle and socioeconomic status. They also suggest that besides improved access to effective medical intervention, there is a need for a comprehensive strategy for health promotion and disease prevention that takes account of individual, cultural and socioeconomic characteristics. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Evolutionary and Ecological Characterization of Mayaro Virus Strains Isolated during an Outbreak, Venezuela, 2010

    PubMed Central

    Auguste, Albert J.; Liria, Jonathan; Forrester, Naomi L.; Giambalvo, Dileyvic; Moncada, Maria; Long, Kanya C.; Morón, Dulce; de Manzione, Nuris; Tesh, Robert B.; Halsey, Eric S.; Kochel, Tadeusz J.; Hernandez, Rosa; Navarro, Juan-Carlos

    2015-01-01

    In 2010, an outbreak of febrile illness with arthralgic manifestations was detected at La Estación village, Portuguesa State, Venezuela. The etiologic agent was determined to be Mayaro virus (MAYV), a reemerging South American alphavirus. A total of 77 cases was reported and 19 were confirmed as seropositive. MAYV was isolated from acute-phase serum samples from 6 symptomatic patients. We sequenced 27 complete genomes representing the full spectrum of MAYV genetic diversity, which facilitated detection of a new genotype, designated N. Phylogenetic analysis of genomic sequences indicated that etiologic strains from Venezuela belong to genotype D. Results indicate that MAYV is highly conserved genetically, showing ≈17% nucleotide divergence across all 3 genotypes and 4% among genotype D strains in the most variable genes. Coalescent analyses suggested genotypes D and L diverged ≈150 years ago and genotype diverged N ≈250 years ago. This virus commonly infects persons residing near enzootic transmission foci because of anthropogenic incursions. PMID:26401714

  14. [National registry on cardiac electrophysiology (2010 and 2011)].

    PubMed

    Madeira, Francisco; Oliveira, Mário; Ventura, Miguel; Primo, João; Bonhorst, Daniel; Morais, Carlos

    2013-02-01

    Based on a survey sent to Portuguese centers that perform diagnostic and interventional electrophysiology and/or implant cardioverter-defibrillators (ICDs), the authors analyze the number and type of procedures performed during 2010 and 2011 and compare these data with previous years. In 2011, a total of 2533 diagnostic electrophysiologic procedures were performed, which were followed by ablation in 2013 cases, a steady increase over previous years. The largest share of this increase compared to 2010 was in atrial fibrillation, which is now the second most frequent indication for ablation, after atrioventricular nodal reentrant tachycardia. The total number of ICDs implanted in 2011 was 1084, of which 339 were biventricular (BiV) cardiac resynchronization devices (BiV ICDs). This represents an increase in the total number relative to previous years, 2011 being the first year in which the rate of new ICD implantations in Portugal exceeded 100 per million population. However, compared to 2010, the number of BiV ICDs implanted decreased, despite the recent publication of updated European guidelines on device therapy in heart failure, which clarified and expanded the indications for implantation of these devices. Some comments are made on the current status of cardiac electrophysiology in Portugal and on factors that may influence its development in the coming years. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Body position and oxygenation: An intriguing relationship.

    PubMed

    Rodrigues, Patrícia; Monteiro, Marta; Palma, Paulo; Sousa-Pereira, Luís; Cabral, Sofia; Oliveira, Filomena; Dias, Vasco; Torres, Severo

    2014-06-01

    Dyspnea and hypoxemia are among the most common symptoms and signs that need to be assessed in clinical practice. This case illustrates how simple steps in history taking and physical examination can be crucial for diagnosis. We present a patient with intermittent hypoxemia, initially attributed to a pulmonary infection. However, the hypoxemia persisted even after successful treatment of the infection. Computed tomography angiography of the chest and ventilation/perfusion lung scan excluded pulmonary embolism. We then observed that the hypoxemia and dyspnea were triggered by orthostatism. An echocardiogram with a bubble test showed a patent foramen ovale, with a right-to-left shunt, without pulmonary hypertension. After percutaneous closure of the foramen ovale, the symptoms completely resolved. This is a case of platypnea-orthodeoxia syndrome, which is usually associated with patent foramen ovale or atrial septal defect and is typically observed in the elderly. The features and causes of this curious syndrome are discussed. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  16. Late atypical atrial flutter after ablation of atrial fibrillation.

    PubMed

    Ferreira, Raquel; Primo, João; Adão, Luís; Gonzaga, Anabela; Gonçalves, Helena; Santos, Rui; Fonseca, Paulo; Santos, José; Gama, Vasco

    2016-10-01

    Cardiac surgery for structural heart disease (often involving the left atrium) and radiofrequency catheter ablation of atrial fibrillation have led to an increased incidence of regular atrial tachycardias, often presenting as atypical flutters. This type of flutter is particularly common after pulmonary vein isolation, especially after extensive atrial ablation including linear lesions and/or defragmentation. The authors describe the case of a 51-year-old man, with no relevant medical history, referred for a cardiology consultation in 2009 for paroxysmal atrial fibrillation. After failure of antiarrhythmic therapy, he underwent catheter ablation, with criteria of acute success. Three years later he again suffered palpitations and atypical atrial flutter was documented. The electrophysiology study confirmed the diagnosis of atypical left flutter and reappearance of electrical activity in the right inferior pulmonary vein. This vein was again ablated successfully and there has been no arrhythmia recurrence to date. In an era of frequent catheter ablation it is essential to understand the mechanism of this arrhythmia and to recognize such atypical flutters. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. In-hospital acute myocardial infarction: A case of type II Kounis syndrome.

    PubMed

    Marinheiro, Rita; Amador, Pedro; Semedo, Filipa; Sá, Catarina; Duarte, Tatiana; Gonçalves, Sara; Seixo, Filipe; Caria, Rui

    2017-05-01

    Kounis syndrome (KS) is the coincidental occurrence of acute coronary syndrome (ACS) and anaphylactic or allergic insult. It results from mast cell degranulation with subsequent release of numerous inflammatory mediators, leading to coronary vasospasm or atheromatous plaque rupture. Diagnosis is clinical and based on the temporal relationship between the two events. Despite the growing number of reported cases, especially in southern Europe, the lack of awareness of this association may lead to under-reporting in Portugal. Recognition of KS, even if retrospective, has clinical implications since individual atopy must be investigated and desensitization measures should be employed, if possible, to prevent future events. We report the case of a 70-year-old man who was admitted to hospital because of generalized exanthema and itching and onset of chest pain while under observation. Coronary angiography confirmed coronary artery disease and ACS and he was diagnosed as having type II KS. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Gender differences in quality of life perception and cardiovascular risk in a community sample.

    PubMed

    Prata, Joana; Quelhas Martins, Amadeu; Ramos, Sónia; Rocha-Gonçalves, Francisco; Coelho, Rui

    2016-03-01

    Self-reported heath and quality of life is an independent predictor of overall and cardiovascular morbidity and mortality, and incident coronary heart disease. However, less is known regarding how gender differences in cardiovascular risk factors impact quality of life perception. Primary healthcare users (n=261, 158 women) were screened for cardiovascular risk factors and completed the Medical Outcomes Study Short Form (SF-36). Women had significantly lower alcohol consumption, body mass index and exercise frequency than men, but more prevalent psychiatric history, depressive and anxiety symptoms, and negative affectivity. Prevalences of hypertension, diabetes, dyslipidemia and type D personality were similar between genders. Women reported significantly worse quality of life on most SF-36 subscales and gender differences were apparent in predictors of quality of life. Moreover, high negative affectivity was an independent predictor of worse general health for women, whereas high social inhibition and high anxiety had a comparable role for men. Gender specifics in cardiovascular risk factors should be considered in prevention strategies. Women reported significantly worse quality of life, putting them at higher risk for cardiovascular morbidity and mortality. Therefore, gender differences in predictors of quality of life warrant further investigation. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  19. [Epidemiology of ophidism in Venezuela (1996-2004)].

    PubMed

    De Sousa, Leonardo; Bastouri-Carrasco, Jessica; Matos, Mercedes; Borges, Adolfo; Bónoli, Stefano; Vásquez-Suárez, Aleikar; Guerrero, Belsy; Rodríguez-Acosta, Alexis

    2013-06-01

    The data of accidents caused by snakebites in Venezuela, registered at the morbidity statistics of the Direction of Epidemiology and Strategic Analysis of the Ministry of Health and Social Development were analyzed. During the years of 1996-2004, 53,792 snakebites were registered in Venezuela (5,976 cases average per year), with a higher incidence during the year 2004 (7,486 incidents). Zulia reported the highest frequency of all the states (5,975 cases); meanwhile the Midwestern region, constituted by Lara, Portuguesa, Falc6n and Yaracuy states, had a higher morbidity for snake bites. The highest incidence, distributed per states was registered in Cojedes, during the year 2001, with 228.72 cases per 100,000 inhabitants. When it was determined by regions, the highest incidence occurred during the year 2004 at los Llanos with 63.81 per 100,000 inhabitants. The median of the incidence rate for Venezuela during the period was of 21.46 accidents per 100,000 inhabitants. The classification of the endemic areas for ophidism, according to the percentiles 23, 50, 75 and 90, organized the country in: (a) states and regions of very high endemicity, (b) high endemicity, (c) middle, (d) low and (e) very low endemicity. These epidemiological data indicated that the accidents caused by snakes constitute a collective health problem in Venezuela.

  20. Electrocardiographic evaluation in athletes: 'Normal' changes in the athlete's heart and benefits and disadvantages of screening.

    PubMed

    Machado Leite, Sérgio; Freitas, João; Campelo, Manuel; Maciel, M Júlia

    2016-03-01

    Young athletes are considered the healthiest group in society. Although rare, there are still reports of sudden death or cardiac arrest on the playing fields. Clinical evaluation is of paramount importance for the identification of possible pathological states that confer increased risk of these events. Interpretation of the electrocardiogram of young athletes can help identify changes associated with heart disease that might preclude the participation in sports. In this context, it is essential to recognize the electrocardiographic patterns that represent the structural and electrical remodeling resulting from continued adaptation to exercise, and which thus do not increase the risk of adverse events during exercise. The European Society of Cardiology (ESC) and the American Heart Association (AHA) have issued consensus documents summarizing which electrocardiographic abnormalities should be considered 'physiological', resulting from adaptation to exercise ('athlete's heart'), and which should be considered pathological and thus require further study. However, the two societies have different approaches with respect to the electrocardiographic screening of athletes. This paper provides a brief review of current evidence regarding the electrocardiographic findings considered normal and abnormal in athletes, and presents the arguments of the ESC and AHA for electrocardiographic screening in this population. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Caffeine consumption and exacerbations of chronic obstructive pulmonary disease: retrospective study.

    PubMed

    Lopes, P O; Alfaro, T M; Lopes, P; Cunha, R A; Cordeiro, C Robalo

    2015-01-01

    The modulation of adenosine receptors has been proposed as new therapeutic target for chronic obstructive pulmonary disease, but studies in humans were negative. Caffeine is widely consumed and acts by non-selective modulation of these receptors, allowing for a non-interventional evaluation of the purinergic effects on COPD. We evaluated the effects of chronic caffeine consumption on the risk for COPD exacerbations. Retrospective study including patients with COPD. The total number of exacerbations during a three-year period and the mean daily caffeine consumption in the last twenty years were evaluated. A univariate and multiple regression analysis were performed for evaluation of the significant predictors of exacerbations. A total of 90 patients were included. Most were males (82.2%) and had a mean forced expiratory volume in the first second (FEV1) of 57.0±17.1% predicted. The mean daily caffeine consumption was 149.7±140.9mg. There was no correlation between the mean caffeine consumption and exacerbations (p>0.05). Our results suggest that caffeine has no significant effect on the frequency of COPD exacerbations. These conclusions are limited by the sample size and the retrospective nature of the study. Copyright © 2015 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  2. Percutaneous balloon mitral valvuloplasty and closure of the left atrial appendage: Synergy of two procedures in one percutaneous intervention.

    PubMed

    Gemma, Daniele; Moreno Gómez, Raúl; Fernández de Bobadilla, Jaime; Galeote García, Guillermo; López Fernandez, Teresa; López-Mínguez, Jose R; López-Sendón, José L

    2016-11-01

    Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. [European guideline for the management of precancerous conditions in the stomach and it's application to Japan].

    PubMed

    Haruma, Ken; Kamada, Tomoari; Murao, Takahisa; Yamanaka, Yoshiyuki; Ohsawa, Motoyasu; Shiotani, Akiko; Inoue, Kazuhiko

    2013-08-01

    Atrophic gastritis, intestinal metaplasia, and Helicobacter pylori (H. pylori) infection are commonly recognized as the risk factor of gastric cancer. In Japan mass screening by the X-ray examination or endoscopy has been performed for a long time in general population or in work place because of the high death rate and high incidence of gastric cancer. Periodic endoscopy has been recommended for the subjects with atrophic gastritis and/or intestinal metaplasia to detect gastric cancer in early stage. On the other hand, there was no guideline to manage premalignant conditions such as atrophic gastritis, intestinal metaplasia, and dysplasia in foreign countries. Recently the guideline for the management of precancerous conditions and lesions in the stomach (MAPS) has been published by the combined efforts of the European Society of Gastrointestinal Endoscopy, European Helicobacter Study Group, European Society of Pathology, and the Sociedade Portuguesa de Endoscopia Digestiva. In this article the main statements have been discussed on comparing the understandings as the premalignant conditions in Japan.

  4. Evolution of strategic risks under future scenarios for improved utility master plans.

    PubMed

    Luís, Ana; Lickorish, Fiona; Pollard, Simon

    2016-01-01

    Integrated, long-term risk management in the water sector is poorly developed. Whilst scenario planning has been applied to singular issues (e.g. climate change), it often misses a link to risk management because the likelihood of impacts in the long-term are frequently unaccounted for in these analyses. Here we apply the morphological approach to scenario development for a case study utility, Empresa Portuguesa das Águas Livres (EPAL). A baseline portfolio of strategic risks threatening the achievement of EPAL's corporate objectives was evolved through the lens of three future scenarios, 'water scarcity', 'financial resource scarcity' and 'strong economic growth', built on drivers such as climate, demographic, economic, regulatory and technological changes and validated through a set of expert workshops. The results represent how the baseline set of risks might develop over a 30 year period, allowing threats and opportunities to be identified and enabling strategies for master plans to be devised. We believe this to be the first combined use of risk and futures methods applied to a portfolio of strategic risks in the water utility sector.

  5. Flora-On: Occurrence data of the vascular flora of mainland Portugal.

    PubMed

    Pereira, Ana Júlia; Francisco, Ana; Porto, Miguel

    2016-01-01

    The Flora-On dataset currently includes 253,310 occurrence records for the class Embryopsidae (vascular plants), comprising data collated via the platform http://flora-on.pt/ relating to observation records of vascular plants across mainland Portugal. Observations are uploaded directly to the database primarily by experienced botanists and naturalists, typically on a weekly basis, and consist of geo-referenced data points for species (or infraspecific taxa) along with their date of observation and phenological state. The Flora-On project aims to compile and make publicly accessible chorological, ecological, morphological and photographic information for the entire vascular flora of Portugal. The project's website offers powerful query and visualization capabilities, of which we highlight the probabilistic bioclimatic and phenological queries which operate based on the empirical density distributions of species in those variables. Flora-On was created and continues to be maintained by volunteers who are Associate members of Sociedade Portuguesa de Botânica (Botanical Society of Portugal). Given its focus on research-grade and current data, the Flora-On project represents a significant contribution to the knowledge of the present distribution and status of the Portuguese flora.

  6. Nanoparticles, nanotechnology and pulmonary nanotoxicology.

    PubMed

    Ferreira, A J; Cemlyn-Jones, J; Robalo Cordeiro, C

    2013-01-01

    The recently emergent field of Nanotechnology involves the production and use of structures at the nanoscale. Research at atomic, molecular or macromolecular levels, has led to new materials, systems and structures on a scale consisting of particles less than 100 nm and showing unique and unusual physical, chemical and biological properties, which has enabled new applications in diverse fields, creating a multimillion-dollar high-tech industry. Nanotechnologies have a wide variety of uses from nanomedicine, consumer goods, electronics, communications and computing to environmental applications, efficient energy sources, agriculture, water purification, textiles, and aerospace industry, among many others. The different characteristics of nanoparticles such as size, shape, surface charge, chemical properties, solubility and degree of agglomeration will determine their effects on biological systems and human health, and the likelihood of respiratory hazards. There are a number of new studies about the potential occupational and environmental effects of nanoparticles and general precautionary measures are now fully justified. Adverse respiratory effects include multifocal granulomas, peribronchial inflammation, progressive interstitial fibrosis, chronic inflammatory responses, collagen deposition and oxidative stress. The authors present an overview of the most important studies about respiratory nanotoxicology and the effects of nanoparticles and engineered nanomaterials on the respiratory system. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  7. [Economic evaluation of dabigatran for stroke prevention in patients with non-valvular atrial fibrillation].

    PubMed

    Silva Miguel, Luís; Rocha, Evangelista; Ferreira, Jorge

    2013-01-01

    To estimate the cost-effectiveness and cost-utility of dabigatran in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Portugal. A Markov model was used to simulate patients' clinical course, estimating the occurrence of ischemic and hemorrhagic stroke, transient ischemic attack, systemic embolism, myocardial infarction, and intra- and extracranial hemorrhage. The clinical parameters are based on the results of the RE-LY trial, which compared dabigatran with warfarin, and on a meta-analysis that estimated the risk of each event in patients treated with aspirin or with no antithrombotic therapy. Dabigatran provides an increase of 0.331 life years and 0.354 quality-adjusted life years for each patient. From a societal perspective, these clinical gains entail an additional expenditure of 2978 euros. Thus, the incremental cost is 9006 euros per life year gained and 8409 euros per quality-adjusted life year. The results show that dabigatran reduces the number of events, especially the most severe such as ischemic and hemorrhagic stroke, as well as their long-term sequelae. The expense of dabigatran is partially offset by lower event-related costs and by the fact that INR monitoring is unnecessary. It can thus be concluded that the use of dabigatran in clinical practice in Portugal is cost-effective. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. [Implementation of a regional system for the emergency care of acute ischemic stroke: Initial results].

    PubMed

    Soares-Oliveira, Miguel; Araújo, Fernando

    2014-06-01

    Implementing integrated systems for emergency care of patients with acute ischemic stroke helps reduce morbidity and mortality. We describe the process of organizing and implementing a regional system to cover around 3.7 million people and its main initial results. We performed a descriptive analysis of the implementation process and a retrospective analysis of the following parameters: number of patients prenotified by the pre-hospital system; number of times thrombolysis was performed; door-to-needle time; and functional assessment three months after stroke. The implementation process started in November 2005 and ended in December 2009, and included 11 health centers. There were 3574 prenotifications from the prehospital system. Thrombolysis was performed in 1142 patients. The percentage of patients receiving thrombolysis rose during the study period, with a maximum of 16%. Median door-to-needle time was 62 min in 2009. Functional recovery three months after stroke was total or near total in 50% of patients. The regional system implemented for emergency care of patients with acute ischemic stroke has led to health gains, with progressive improvements in patients' access to thrombolysis, and to greater equity in the health care system, thus helping to reduce mortality from cerebrovascular disease in Portugal. Our results, which are comparable with those of international studies, support the strategy adopted for implementation of this system. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Clinical challenges of persistent pulmonary air-leaks--case report.

    PubMed

    van Zeller, M; Bastos, P; Fernandes, G; Magalhães, A

    2014-01-01

    Air leaks are a common problem after pulmonary resection and can be a source of significant morbidity and mortality. The authors describe the case of a 68-year-old male patient who presented with a persistent air-leak after pulmonary resection. Watchful waiting, surgical procedures, as well as medical therapy like pleurodesis and implantation of endobronchial one-way valves on the bronchial segments identified using systematic occlusion of the bronchial segments, were all tried unsuccessfully. During that time the patient remained hospitalized with a chest tube. The instillation of methylene blue through the chest tube was used to identify the segments leading to the persistent air-leak; this enabled successful endobronchial valve placement which sufficiently reduced the size of the air-leak so that the chest tube could be removed. Nonsurgical approaches seem promising and, for some patients may be the only treatment option after all conventional treatments have failed or are considered too high risk. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  10. Aspirin and blood pressure: Effects when used alone or in combination with antihypertensive drugs.

    PubMed

    Costa, Ana Catarina; Reina-Couto, Marta; Albino-Teixeira, António; Sousa, Teresa

    Arterial hypertension is a major risk factor for cardiovascular and renal events. Lowering blood pressure is thus an important strategy for reducing morbidity and mortality. Since low-dose aspirin is a cornerstone in the prevention of adverse cardiovascular outcomes, combined treatment with aspirin and antihypertensive drugs is very common. However, the impact of aspirin therapy on blood pressure control remains a subject of intense debate. Recent data suggest that the cardioprotective action of aspirin extends beyond its well-known antithrombotic effect. Aspirin has been shown to trigger the synthesis of specialized pro-resolving lipid mediators from arachidonic acid and omega-3 fatty acids. These novel anti-inflammatory and pro-resolving mediators actively stimulate the resolution of inflammation and tissue regeneration. Additionally, they may contribute to other protective effects on redox status and vascular reactivity that have also been attributed to aspirin. Of note, aspirin has been shown to improve vasodilation through cyclooxygenase-independent mechanisms. On the other hand, higher aspirin doses have been reported to exert a negative impact on blood pressure due to inhibition of cyclooxygenase-2 activity, which reduces renal blood flow, glomerular filtration rate and sodium and water excretion. This review aims to provide an overview of the effects of aspirin on blood pressure and the underlying mechanisms, focusing on the interaction between aspirin and antihypertensive drugs. Studies in both experimental and human hypertension are presented. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Hypertensive patients in a general practice setting: comparative analysis between controlled and uncontrolled hypertension.

    PubMed

    Santiago, Luiz Miguel; Pereira, Carolina; Botas, Philippe; Simões, Ana Rita; Carvalho, Rosa; Pimenta, Gonçalo; Neto, Glória

    2014-01-01

    To study the differences between controlled and uncontrolled hypertensive patients. This was a cross-sectional observational study of the hypertensive population on the lists of three general practitioners in the district of Coimbra in central Portugal in 2013, with a margin of error of 6% and 95% confidence interval in each sample, organized in ascending order of health care user numbers. Data were gathered electronically by the investigators after approval by the Regional Health Authority's ethics committee. A sample of 201 individuals was studied, of whom 104 (51.7%) were male and 86 (42.8%) were aged under 65 (p=0.127 for gender and age-group). Hypertension was controlled in 130 (64.7%). We found significant differences in target organ damage, more frequent in those with controlled hypertension (33.1% vs. 19.7%, p=0.031), in hypertension control, better in those taking at least one anti-hypertensive drug at night (56.9% vs. 29.6%, p<0.001), and in prescription of non-steroidal anti-inflammatory drugs, more frequent in those with uncontrolled hypertension (11.3% vs. 3.8%, p=0.043). Hypertension control is significantly associated with target organ damage, taking at least one anti-hypertensive drug at night and not taking non-steroidal anti-inflammatory drugs simultaneously. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. Prosthetic aortic valve: a bone in the system.

    PubMed

    Pereira, Vitor Hugo; Guardado, Joana; Fernandes, Marina; Lourenço, Mário; Machado, Inocência; Quelhas, Isabel; Azevedo, Olga; Lourenço, António

    2015-02-01

    We report a case of a 73-year-old female patient admitted to the surgical department for a splenic abscess. She had a history of a mechanical aortic valve implanted two years earlier. During the diagnostic work-up, the patient underwent a transesophageal echocardiogram that revealed the presence of multiple paravalvular abscesses, establishing the diagnosis of prosthetic valve endocarditis. A few days later, the echocardiogram was repeated due to a new-onset systolic-diastolic murmur. A large pseudoaneurysm and significant periprosthetic regurgitation were now noted and the patient was referred for cardiac surgery. The microbiologic exam revealed the presence of Streptococcus milleri, usually found in the gastrointestinal flora and a known pathogenic agent of endocarditis. Interestingly, the patient had had a foreign body (bone fragment) removed from her esophagus a few weeks earlier, which was the probable portal of entry for this infective endocarditis. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report.

    PubMed

    Brandão, Mariana; Almeida, Jorge; Ferraz, Rita; Santos, Lurdes; Pinho, Paulo; Casanova, Jorge

    2016-09-01

    Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. Candida albicans is the most common etiological agent for this rare but increasingly frequent condition. We present a case of fungal prosthetic valve endocarditis due to C. albicans following aortic and pulmonary valve replacement in a 38-year-old woman with a history of surgically corrected tetralogy of Fallot, prior infective endocarditis and acute renal failure with need for catheter-based hemodialysis. Antifungal therapy with liposomal amphotericin B was initiated prior to cardiac surgery, in which the bioprostheses were replaced by homografts, providing greater resistance to recurrent infection. During hospitalization, a mycotic aneurysm was diagnosed following an episode of acute arterial ischemia, requiring two vascular surgical interventions. Despite the complications, the patient's outcome was good and she was discharged on suppressive antifungal therapy with oral fluconazole for at least a year. The reported case illustrates multiple risk factors for fungal endocarditis, as well as complications and predictors of poor prognosis, demonstrating its complexity. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. A Astronomia no Ensino Superior Brasileiro entre 1808 e 1889

    NASA Astrophysics Data System (ADS)

    Bretones, Paulo S.; Videira, Antonio A. P.

    2003-05-01

    Este artigo apresenta os principais eventos ocorridos na história do ensino de astronomia nos cursos superiores que existiram no Brasil desde a chegada da Família Real portuguesa em 1808 até o final do período monárquico. Para compor esse esboço histórico, utilizamos, principalmente, livros didáticos, regulamentos, decretos e leis responsáveis pelas organizações dos conteúdos oferecidos e das carreiras dos responsáveis pela disciplina. Na análise do material empregado, investigamos a presença de concepções filosóficas e científicas, que podem ter norteado os conteúdos disciplinares. Não realizamos nenhuma comparação com o ensino de astronomia em outros países. Concluímos mostrando que o estudo de astronomia, durante o período monárquico, foi mais direcionado para a formação d engenheiros do que astrônomos. Gostaríamos de observar que o presente artigo não tem a pretensão de abordar o assunto de maneira completa e detalhada.

  15. Psychiatry training towards a global future: trainees' perspective in Portugal.

    PubMed

    Pinto da Costa, Mariana; Guerra, Cátia; Malta, Rui; Moura, Manuela; Carvalho, Serafim; Mendonça, Denisa

    2013-01-01

    Introdução: A psiquiatria é influenciada pelas mudanças que ocorrem na sociedade, devendo estar em constante renovação, antevendo futuros comportamentos e doenças. Este estudo pretende descrever a opinião dos internos de psiquiatria em Portugal relativamente ao seu internato e às modificações que nele gostariam de assistir no futuro próximo.Material e Métodos: Um questionário estruturado de 26 perguntas foi desenvolvido pela Associação Portuguesa de Internos de Psiquiatria e enviado por email.Resultados: A percentagem de respostas obtidas foi de 41,5%. A maioria dos internos estava satisfeita com a sua formação. Contudo, algumas mudanças foram sugeridas no que diz respeitos aos estágios obrigatórios e opcionais. A maior parte dos internos requer que as psicoterapias sejam incluídas no âmbito do internato, solicitando também um acesso mais fácil à investigação e a oportunidades de estágio no estrangeiro.Discussão e Conclusão: Esta perspectiva detalhada pode facilitar a transformação dos currículos do internato em Portugal e naEuropa, permitindo a melhoria do internato de psiquiatria, bem como dos cuidados de saúde mental.

  16. Association between congenital heart defects and severe infections in children with Down syndrome.

    PubMed

    Faria, Paula Foresti; Nicolau, Juliana Augusta Zeglin; Melek, Marina Zaponi; de Oliveira, Nanci de Santa Palmieri; Bermudez, Beatriz Elizabeth Bagatin Veleda; Nisihara, Renato Mitsunori

    2014-01-01

    There is a high prevalence of congenital heart disease (CHD) in Down syndrome (DS) patients. Children with DS and CHD also present greater susceptibility to pulmonary infections than those without CHD. To investigate the prevalence and types of CHD and their association with severe infections in children with DS in southern Brazil seen in a reference outpatient clinic. Children aged between six and 48 months with a diagnosis of DS were included consecutively in the period May 2001 to May 2012, and the presence of CHD and severe infections (pneumonia and sepsis) was investigated, classified and analyzed. A total of 127 patients were included, of whom 89 (70.1%) had some type of CHD, 33 (37.7%) of them requiring surgical correction. Severe infections (pneumonia and sepsis) were seen in 23.6% and 5.5%, respectively. Of the cases of pneumonia, 70% had associated CHD (p=0.001) and of those with sepsis, 85% presented CHD (p=0.001). Our study showed a high prevalence of CHD and its association with severe infections in children with DS seen in southern Brazil. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  17. A protocol proposition of cell therapy for the treatment of chronic obstructive pulmonary disease.

    PubMed

    Ribeiro-Paes, J T; Stessuk, T; Marcelino, M; Faria, C; Marinelli, T; Ribeiro-Paes, M J

    2014-01-01

    The main feature of pulmonary emphysema is airflow obstruction resulting from the destruction of the alveolar walls distal to the terminal bronchioles. Existing clinical approaches have improved and extended the quality of life of emphysema patients. However, no treatment currently exists that can change the disease course and cure the patient. The different therapeutic approaches that are available aim to increase survival and/or enhance the quality of life of emphysema patients. In this context, cell therapy is a promising therapeutic approach with great potential for degenerative pulmonary diseases. In this protocol proposition, all patients will be submitted to laboratory tests, such as evaluation of heart and lung function and routine examinations. Stem cells will be harvested by means of 10 punctures on each anterior iliac crest, collecting a total volume of 200mL bone marrow. After preparation, separation, counting and labeling (optional) of the mononuclear cells, the patients will receive an intravenous infusion from the pool of Bone Marrow Mononuclear Cells (BMMC). This article proposes a rational and safe clinical cellular therapy protocol which has the potential for developing new projects and can serve as a methodological reference for formulating clinical application protocols related to the use of cellular therapy in COPD. This study protocol was submitted and approved by the Brazilian National Committee of Ethics in Research (CONEP - Brazil) registration number 14764. It is also registered in ClinicalTrials.gov (NCT01110252). Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  18. Children's exposure to second hand smoke at home: a cross-sectional study in Portugal.

    PubMed

    Vitória, Paulo D; Machado, José Cunha; Araújo, Ana Carolina; Ravara, Sofia B; Samorinha, Catarina; Antunes, Henedina; Rosas, Manuel; Becoña, Elisardo; Precioso, José

    2015-01-01

    Second-hand tobacco smoke (SHS) is a major indoor pollutant that causes serious health problems for all exposed, especially children. Children are often exposed to SHS at home, due to parental or other households' or guests' smoking. This study describes Portuguese children's exposure to SHS at home (total and by Portuguese main regions). In 2010/2011, a questionnaire was applied to a sample of Portuguese children in the 4th grade (N=3187, mean age 9.05±0.7 years, 51.1% male). Descriptive analysis, chi-square tests and crude odds ratios were performed. Of the participants, 62.9% of those with smoking parents and 19.2% of those with non-smoking parents were exposed to SHS at their home. Parental smoking varied significantly among regions and was significantly associated with children's exposure to SHS at home. Children's exposure to SHS at home was high, especially if their parents smoke. Children living in Lisbon Region presented the highest SHS exposure rate. The association of SHS exposure with geographic regions suggests the influence of social and contextual factors on smoking behaviour and on tobacco control effectiveness. Our findings highlight the need to effectively prevent children's SHS exposure at their home and to develop tailored tobacco control measures by region. Copyright © 2014 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  19. Mid-regional pro-adrenomedullin and ST2 in heart failure: Contributions to diagnosis and prognosis.

    PubMed

    Lopes, Daniela; Menezes Falcão, Luiz

    2017-06-01

    Heart failure has a high prevalence in developed countries. It is a frequent cause of hospital admission and has an important impact on morbidity, mortality and healthcare costs. Biomarkers have been widely studied in heart failure, as they improve diagnosis and prognostic assessment. Natriuretic peptides are already a part of daily clinical practice but several other biomarkers are being studied. This review focuses on mid-regional pro-adrenomedullin (MR-proADM) and ST2. Neither of these biomarkers is useful in the diagnosis of acute heart failure. However, both have considerable short- and long-term prognostic value in patients with acute and with stable chronic heart failure. The utility of these two biomarkers in guiding heart failure treatment is yet to be established. ST2 appears to have some advantages compared to MR-proADM, because it is more closely associated with ventricular remodeling and fibrosis. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Pulse pressure can predict mortality in advanced heart failure.

    PubMed

    Ferreira, Ana Rita; Mendes, Sofia; Leite, Luís; Monteiro, Sílvia; Pego, Mariano

    2016-04-01

    Pulse pressure (PP) is the difference between systolic and diastolic blood pressure (BP). PP rises markedly after the fifth decade of life. High PP is a risk factor for the development of coronary heart disease and heart failure. The aim of this study was to assess whether PP can be used as a prognostic marker in advanced heart failure. We retrospectively studied patients in NYHA class III-IV who were hospitalized in a single heart failure unit between January 2003 and August 2012. Demographic characteristics, laboratory tests, and cardiovascular risk factors were recorded. PP was calculated as the difference between systolic and diastolic BP at admission, and the patients were divided into two groups (group 1: PP >40 mmHg and group 2: PP ≤40 mmHg). Median follow-up was 666 ± 50 days for the occurrence of cardiovascular death and heart transplantation. During follow-up 914 patients in NYHA class III-IV were hospitalized, 520 in group 1 and 394 in group 2. The most important difference between the groups was in left ventricular dysfunction, which was greater in patients with lower PP. On Kaplan-Meier analysis, group 2 had higher mortality (38 vs. 24 patients, log-rank p=0.002). PP is easily calculated, and enables prediction of cardiovascular death in patients with advanced heart failure. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Telemonitoring in heart failure: a state-of-the-art review.

    PubMed

    Sousa, Carla; Leite, Sérgio; Lagido, Ricardo; Ferreira, Liliana; Silva-Cardoso, José; Maciel, Maria Júlia

    2014-04-01

    Heart failure is associated with high costs which are mainly the result of recurrent hospital admissions. New strategies to detect early decompensation and prevent heart failure-related hospitalizations and reduce total health care costs are needed. Telemonitoring is a novel tool based on the use of recent communication technologies to monitor simple clinical variables, in order to enable early detection of heart failure decompensation, providing an opportunity to prevent hospitalization. From conventional telemonitoring to more recent strategies using implantable cardiac devices or implantable hemodynamic monitors, the subject is under active investigation. Despite the beneficial effects reported by meta-analyses of small non-controlled studies, major randomized controlled trials have failed to demonstrate a positive impact of this strategy. Additionally, evidence regarding the value of newer monitoring devices is somewhat contradictory, as some studies show benefits in prognosis which are not confirmed by others. This paper provides an overview of the existing evidence on telemonitoring in heart failure and a comprehensive state-of-the-art discussion on this topic. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  2. [Tannins, phytic phosphorus, phytase activity in the seed of 12 sorghum grain hybrids (Sorghum bicolor (L) Moench)].

    PubMed

    Ojeda, Alvaro; Frías, Amarayma; González, Rafael; Linares, Zoraida; Pizzani, Pablo

    2010-03-01

    In order to evaluate the variability in concentration of secondary metabolites among grains from different sorghum hybrids (Sorghum bicolor (L) Moench) and provide some information for rational use in animal feeds, grain samples were collected from 12 hybrids (Criollo 1, Criollo 27, Chaguaramas III, Chaguaramas VII, Cristiani Burkard H-8046-2, Guanipa 95, Himeca 101, Himeca 400, Pioneer 81-G67, Pioneer 83-G88, Pioneer 86-P42 y Tecsem 120) sowed on 2008 in the Turén municipality, Portuguesa State-Venezuela. Using standardized analytical methods, hybrids showed polyphenolics compounds contents (0.92 +/- 0.37% TaE), total (0.61 +/- 0.29% TaE) and condensed tannins (0.95 +/- 0.65% LeuE), phytic phosphorus (0.17 +/- 0.03%) and intrinsic phytase activity (12.3 +/- 6.74 U/kg) in the ranges described in the literature, with an important variation among hybrids that must be considered for their inclusion levels in the formulation of balanced feeds, as well as plant breeding programs.

  3. The importance of the neutrophil-to-lymphocyte ratio in patients with hypertrophic cardiomyopathy.

    PubMed

    Ozyilmaz, Sinem; Akgul, Ozgur; Uyarel, Huseyin; Pusuroglu, Hamdi; Gul, Mehmet; Satilmisoglu, Muhammet Hulusi; Bolat, Ismail; Ozyilmaz, Isa; Uçar, Hakan; Yildirim, Aydin; Bakir, Ihsan

    2017-04-01

    Previous studies have demonstrated the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in many cardiovascular disorders. The aim of this study was to assess whether NLR is associated with echocardiographic or electrocardiographic parameters, or with predicted five-year risk of sudden cardiac death (SCD), in patients with hypertrophic cardiomyopathy (HCM). This prospective observational study included 74 controls and 97 HCM patients. Three years of follow-up results for HCM patients were evaluated. NLR was significantly higher in patients with fragmented QRS, ventricular tachycardia, and presyncope than in those without (p=0.031, 0.030, and 0.020, respectively). NLR was significantly higher in patients whose predicted five-year risk of SCD was more than 6% and whose corrected QT interval was greater than 440 ms (p=0.022 and 0.001, respectively). It was also significantly higher in patients whose left ventricular ejection fraction (LVEF) was <60% than in those with LVEF >60% (p=0.017). NLR was significantly higher in patients with HCM compared to the control group. A high NLR is associated with a higher five-year risk of SCD in patients with HCM. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Complex phenotype linked to a mutation in exon 11 of the lamin A/C gene: Hypertrophic cardiomyopathy, atrioventricular block, severe dyslipidemia and diabetes.

    PubMed

    Francisco, Ana Rita G; Santos Gonçalves, Inês; Veiga, Fátima; Mendes Pedro, Mónica; Pinto, Fausto J; Brito, Dulce

    2017-09-01

    The lamin A/C (LMNA) gene encodes lamins A and C, which have an important role in nuclear cohesion and chromatin organization. Mutations in this gene usually lead to the so-called laminopathies, the primary cardiac manifestations of which are dilated cardiomyopathy and intracardiac conduction defects. Some mutations, associated with lipodystrophy but not cardiomyopathy, have been linked to metabolic abnormalities such as diabetes and severe dyslipidemia. Herein we describe a new phenotype associated with a mutation in exon 11 of the LMNA gene: hypertrophic cardiomyopathy, atrioventricular block, severe dyslipidemia and diabetes. A 64-year-old woman with hypertrophic cardiomyopathy and a point mutation in exon 11 of the LMNA gene (c.1718C>T, Ser573Leu) presented with severe symptomatic ventricular hypertrophy and left ventricular outflow tract obstruction. She underwent septal alcohol ablation, followed by Morrow myectomy. The patient was also diagnosed with severe dyslipidemia, diabetes and obesity, and fulfilled diagnostic criteria for metabolic syndrome. No other characteristics of LMNA mutation-related phenotypes were identified. The development of type III atrioventricular block with no apparent cause, and mildly depressed systolic function, prompted referral for cardiac resynchronization therapy. In conclusion, the association between LMNA mutations and different phenotypes is complex and not fully understood, and can present with a broad spectrum of severity. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. [Patients attended at a Venezuelan Toxicology Centre].

    PubMed

    Tagliaferro, Zulay A; Bracamonte, Giannina

    2010-04-01

    Characterising patients attended at a toxicological centre in the central western area of Venezuela (the state of Lara). This was a descriptive/cross-sectional study. The population consisted of 1,938 patients who registered during 2006 and 2007; data was collected from the Centre's data collection forms. 57.4 % of the patients recorded on the toxicological centre's forms during 2006 and 2007 consulted during 2006. The patients' average age was 19 during 2006 (including adults and teenagers) and 20 during 2007. Males most often attended the centre (55.4 %). The most common cause for consultation was poisoning from snake bite, more than 40 % of the cases being caused by Bothrops. Pesticide intoxication was the second cause for male consultation (20.6 %); female medication poisoning accounted for 26.6 %. Iribarren County had the highest consultation rate in the State of Lara (47.8 % of cases). 95 patients (4.9 %) came from neighbouring States (Portuguesa and Yaracuy) during the two years this study lasted. It is hoped that this study will lead to special education and attention programmes for the most commonly diagnosed pathologies being implemented with greater frequency, as well as corrective action being taken regarding individual and collective risk in the state of Lara's different geographical areas.

  6. [Fatty acids profile characterization of white maize hybrids grown in Venezuela].

    PubMed

    Alezones, Jesús; Avila, Manuel; Chassaigne, Alberto; Barrientos, Venancio

    2010-12-01

    In Venezuela, white corn is the most important crop regarding production, harvest area and consumption. One of its main by-products is corn oil, whose positive effect on health caused by the high content of unsaturated fatty acids has been widely recognized. In order to characterize the fatty acids profile of twelve white grained maize hybrids extensively grown in Venezuela, and the effect that divergent localities has on this profile, three semi commercial scale trials where established in Portuguesa, Yaracuy and Guárico states. Proportions of the main fatty acids in the raw oil of the different grain samples were determined using gas chromatography. Significant differences (p < 0,01) between hybrids were found for arachidic, palmitic, stearic, oleic, gadoleic and linoleic acids; non significant differences were found for linolenic acid. Significant differences between localities were found for all the fatty acids evaluated. High and significant correlations between fatty acids content were found; the most important relations were: linoleic-oleic (Rho = -0,98**), arachidic-palmitic (Rho = -0,61**), linoleic-stearic (Rho = -0,61**) and oleic-stearic (Rho = 0,58**). Corn produced in Venezuela presents lower levels of linoleic and higher levels of palmitic, stearic and oleic acids than the levels found in temperate corn. These differences involve significant changes in the nutritional properties of Venezuelan corn oil that should be considered in the development of new cultivars and industrial processes for oil production.

  7. Ventricular septal defect in children and adolescents in Angola: experience of a tertiary center.

    PubMed

    Manuel, Valdano; Morais, Humberto; Manuel, Ana; David, Bruna; Gamboa, Sebastiana

    2014-10-01

    This is the first study in Angola with the aim of characterizing ventricular septal defect (VSD) among children and adolescents. A cross-sectional study based on echocardiographic records of the largest pediatric cardiology center in Angola included all children and adolescents (0 to 18 years old) with VSD between April 2010 and March 2011. The diagnosis was made by transthoracic and Doppler echocardiography with a Medison SA 8000 system. The sample was divided into two groups: Group 1, isolated VSD; and Group 2, VSD associated with other congenital heart defects (CHDs). Age, gender, type of VSD, associated CHDs and genetic syndromes were assessed. A total of 490 CHDs were diagnosed, of which 283 were VSDs. In Group 1 (140, 49%) the mean age was 29±36 months. The most frequent age (mode) at diagnosis was 24 months. There was no predominance of gender (ratio 1:1). The majority (127, 91%) had perimembranous VSD. In Group 2 (143, 51%) 113 patients (79%) had one, 27 patients (19%) had two and three patients (2%) had three other CHDs. Trisomy 21 was the most common genetic syndrome (23, 96%). The study shows that VSD is the most common CHD in childhood, the diagnosis is made late and almost half of VSDs are associated with other CHDs. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Characterization of left atrial dysfunction in hypereosinophilic syndrome - Insights from the Motion analysis of the heart and great vessels by three-dimensional speckle tracking echocardiography in pathological cases (MAGYAR-Path) Study.

    PubMed

    Nemes, Attila; Marton, Imelda; Domsik, Péter; Kalapos, Anita; Pósfai, Éva; Modok, Szabolcs; Borbényi, Zita; Forster, Tamás

    2016-05-01

    The present study was designed to compare three-dimensional speckle tracking echocardiography (3DSTE)-derived left atrial (LA) volumetric, volume-based functional and strain parameters between patients with hypereosinophilic syndrome (HES) and matched controls. A total of 10 HES patients and 19 age- and gender-matched healthy controls were included in the study. Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all HES cases and controls. Significantly increased maximum (72.9±38.8 ml vs. 45.6±15.5 ml, p=0.01) and minimum (46.3±33.3 ml vs. 26.0±15.0 ml, p=0.03) LA volumes and LA volume before atrial contraction (62.0±36.0 ml vs. 36.5±16.6 ml, p=0.01) were found in HES patients compared to controls. Both peak global (18.3±6.7% vs. 25.6±9.0%, p=0.03) and mean segmental (22.2±6.0% vs. 31.0±12.1%, p=0.04) circumferential strains were significantly reduced in HES patients, suggesting decreased LA reservoir function. Increased LA volumes can be demonstrated in HES patients, accompanied by reduced LA peak circumferential strain as assessed by 3DSTE, suggesting LA remodeling. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Left ventricular pseudoaneurysm - a challenging diagnosis.

    PubMed

    Faustino, Mariana; Ranchordás, Sara; Abecasis, João; Freitas, António; Ferreira, Moradas; Gil, Victor; Morais, Carlos; Neves, José Pedro

    2016-06-01

    Left ventricular pseudoaneurysm is a rare complication of acute myocardial infarction, associated with high mortality. However, it can present in a non-specific manner, complicating and delaying the diagnosis. The authors present the case of a 65-year-old patient, hypertensive, with no other known relevant medical history, who presented with chest pain, cough and left pleural effusion, initially attributed to a pulmonary process. However, these were in fact the result of a left ventricular pseudoaneurysm following silent acute myocardial infarction. The diagnosis was suspected on echocardiography and confirmed by cardiac magnetic resonance imaging, and the patient underwent successful surgical pseudoaneurysm repair. This case illustrates an atypical presentation of a left ventricular pseudoaneurysm, in which the manifestations resulted from pericardial and pleural extension of the inflammatory process associated with contained myocardial rupture. The case demonstrates the need for a high index of suspicion, and the value of imaging techniques to confirm it, in order to proceed with appropriate surgical treatment, and thus modify the course of the disease. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Translation and cultural adaptation of the Hill-Bone Compliance to High Blood Pressure Therapy Scale to Portuguese.

    PubMed

    Nogueira-Silva, Luís; Sá-Sousa, Ana; Lima, Maria João; Monteiro, Agostinho; Dennison-Himmelfarb, Cheryl; Fonseca, João A

    2016-02-01

    Hypertension is an extremely prevalent disease worldwide and hypertension control rates remain low. Lack of adherence contributes to poor control and to cardiovascular events. No questionnaire in Portuguese is readily available for the assessment of adherence to antihypertensive drugs. We aimed to perform a translation and cultural adaptation to Portuguese of the Hill-Bone Compliance to High Blood Pressure Therapy Scale, a validated instrument to measure adherence in hypertensive patients. A formal process was employed, consisting of a forward translation by two independent translators and a back translation by a third translator. Discrepancies were resolved after each step. Hypertensive patients were involved to identify and resolve phrasing and wording difficulties and misunderstandings. The forward and back translation did not produce significant discrepancies. However, important issues were identified when the questionnaire was presented to patients, which led to changes in the wording of the questions and in the format of the questionnaire. Questionnaires are important instruments to assess adherence to therapy, particularly in hypertension. A formal translation and cultural adaptation process ensures that the new version maintains the same concepts as the original. After translation, several changes were necessary to ensure that the questionnaire was understandable by elderly, low literacy patients, such as the majority of hypertensive patients. We propose a Portuguese version of the Hill-Bone Compliance Scale, which will require validation in further studies. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. [Prevalence of human infections by Trypanosoma cruzi in blood banks in Venezuela].

    PubMed

    Aché, A

    1993-01-01

    Primary investigations carried out in blood banks in Venezuela during the 1950s, indicated that overall seroprevalence for Trypanosoma cruzi infection was 12% amongst blood donors. In Venezuela, blood donation is free. All public and private blood banks are controlled by the Ministry of Health. As from 1988 the ELISA technique was uniformly used in blood banks for the detection of T. cruzi infections. Annual median seroprevalence, between 1988 to 1992, was 1.20% (1.09-1.94%), with geographical variations between localities in several States. States with higher prevalence rates are located in the western and central part of Venezuela: Portuguesa, Lara, Trujillo, Cojedes and Carabobo. Due to difficulties in obtaining incidence rates for Chagas disease, it seems proper to use prevalence rates due to its greater stability; and in the specific case of Venezuela, due to a lesser severity and a higher survival of this disease at present. Considering that there is little to be offered to the seropositive individual, repeatability is avowed for serological diagnosis. Specificity should be strived for in the light of lower prevalence rates at present.

  12. Stent for Life in Portugal: This initiative is here to stay.

    PubMed

    Pereira, Hélder; Pinto, Fausto J; Calé, Rita; Pereira, Ernesto; Marques, Jorge; Almeida, Manuel; de Mello, Sofia; Dias Martins, Luís

    2014-06-01

    Portugal has one of the lowest rates of primary percutaneous coronary intervention (p-PCI) in Western Europe. This study assessed the progress of Portuguese p-PCI performance indicators one year after Portugal joined the Stent for Life (SFL) initiative. Two national surveys were carried out, each covering a period of one month: the first when Portugal joined the SFL in 2011 (Moment Zero), and the second one year later (Moment One). A total of 397 consecutive patients with probable ST-segment elevation myocardial infarction were enrolled (201 at Moment Zero and 196 at Moment One) from 15 centers. During this period, the number of patients who arrived at a local hospital without p-PCI decreased (62-47%; p=0.004) and transportation to a p-PCI hospital by the National Institute for Medical Emergencies (INEM) increased significantly (13-37%; p<0.001). Shorter times to revascularization were observed, due to shorter patient delay (118-102 min; p=0.008). Door-to-balloon delay and system delay remained unchanged. Improvements in performance indicators for p-PCI demonstrate the success of the first year of the local SFL plan, which was mainly focused on raising public awareness of the need to use the INEM emergency services, which has reduced patient delay, and on improving secondary transportation. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Flora-On: Occurrence data of the vascular flora of mainland Portugal

    PubMed Central

    Pereira, Ana Júlia; Francisco, Ana; Porto, Miguel

    2016-01-01

    Abstract The Flora-On dataset currently includes 253,310 occurrence records for the class Embryopsidae (vascular plants), comprising data collated via the platform http://flora-on.pt/ relating to observation records of vascular plants across mainland Portugal. Observations are uploaded directly to the database primarily by experienced botanists and naturalists, typically on a weekly basis, and consist of geo-referenced data points for species (or infraspecific taxa) along with their date of observation and phenological state. The Flora-On project aims to compile and make publicly accessible chorological, ecological, morphological and photographic information for the entire vascular flora of Portugal. The project’s website offers powerful query and visualization capabilities, of which we highlight the probabilistic bioclimatic and phenological queries which operate based on the empirical density distributions of species in those variables. Flora-On was created and continues to be maintained by volunteers who are Associate members of Sociedade Portuguesa de Botânica (Botanical Society of Portugal). Given its focus on research-grade and current data, the Flora-On project represents a significant contribution to the knowledge of the present distribution and status of the Portuguese flora. PMID:27698587

  14. Heart rate variability in myocardial infarction patients: effects of exercise training.

    PubMed

    Oliveira, Nórton Luís; Ribeiro, Fernando; Alves, Alberto Jorge; Teixeira, Madalena; Miranda, Fátima; Oliveira, José

    2013-09-01

    Heart rate variability (HRV) is a simple and noninvasive measure that estimates cardiac autonomic modulation, mainly the parasympathetic contribution. Increased sympathetic and/or decreased parasympathetic nervous activity is seen in post-myocardial infarction (MI) patients. Consequently, these patients present reduced HRV, which has been associated with increased risk of adverse events and mortality. Exercise training, recommended as a complementary therapy for patients with cardiovascular disease, has shown numerous beneficial effects. The main aim of the present manuscript was to provide a critical review of studies investigating the effects of exercise training on cardiac autonomic modulation, through HRV, in MI patients and the possible mechanisms involved. Despite conflicting evidence, exercise training appears to be a useful therapeutic intervention to improve the unbalanced autonomic function of MI patients. Finally, the mechanisms involved are not yet well understood, but nitric oxide bioavailability and angiotensin II levels seem to play an important role. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Construction of high-resolution stochastic geological models and optimal upscaling to a simplified layer-type hydrogeological model

    NASA Astrophysics Data System (ADS)

    Quental, Paulo; Almeida, José António; Simões, Manuela

    2012-04-01

    Despite inequalities in spatial resolution between stochastic geological models and flow simulator models, geostatistical algorithms are used for the characterisation of groundwater systems. From available data to grid-block hydraulic parameters, workflows basically utilise the development of a detailed geostatistical model (morphology and properties) followed by upscaling. This work aims to design and test a two-step methodology encompassing the generation of a high-resolution 3D stochastic geological model and simplification into a low-resolution groundwater layer-type model. First, a high-resolution 3D stochastic model of rock types or hydrofacies (sets of rock types with similar hydraulic characteristics) is generated using an enhanced version of the sequential indicator simulation (SIS) with corrections for local probabilities and for two- and three-point template statistics. In a second step, the high-resolution geological model provided by SIS is optimally simplified into a small set of layers according to a supervised simulated annealing (SA) optimisation procedure and at the end equivalent hydraulic properties are upscaled. Two outcomes are provided by this methodology: (1) a regular 2D mesh of the top and bottom limits of each hydrogeological unit or layer from a conceptual model and (2), for each layer, a 2D grid-block of equivalent hydraulic parameters prepared to be inputted into an aquifer simulator. This methodology was tested for the upper aquifer area of SPEL (Sociedade Portuguesa de Explosivos), an explosives deactivation plant in Seixal municipality, Portugal.

  16. [Transport of mucoid mucus in healthy individuals and patients with chronic obstructive pulmonary disease and bronchiectasis].

    PubMed

    Lima Afonso, J; Tambascio, J; Dutra de Souza, H C; Jardim, J R; Baddini Martinez, J A; Gastaldi, A C

    2013-01-01

    To characterise and compare the in vitro transport properties of respiratory mucoid secretion in individuals with no lung disease and in stable patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis. Samples of mucus were collected, from 21 volunteers presenting no lung disease who had undergone surgery, from 10 patients presenting chronic COPD, and from 16 patients with bronchiectasis. Mucociliary transport (MCT), transport by cough (SCM), and contact angle (CAM) were evaluated. MCT was found to be greater in healthy individuals (1.0±0.19) than in COPD (0.91±0.17) and bronchiectasis (0.76±0.23) patients (p<0.05), whereas SCM was greater in COPD patients (16.31±7.35 cm) than in patients with bronchiectasis (12.16±6.64 cm) and healthy individuals (10.50±25.8 cm) (p<0.05). No significant differences were observed between the groups regarding CAM. Mucus from healthy individuals allows better mucociliary transport compared to that from patients with lung diseases. However, the mucus from COPD patients allows a better transport by coughing, demonstrating that these individuals have adapted to a defence mechanism compared to patients with bronchiectasis, who have impairment in their ciliary and cough transport mechanisms. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  17. Physical performance, quality of life and sexual satisfaction evaluation in adults with cystic fibrosis: An unexplored correlation.

    PubMed

    Aguiar, K C A; Marson, F A L; Gomez, C C S; Pereira, M C; Paschoal, I A; Ribeiro, A F; Ribeiro, J D

    Quality of life (QOL), sexual satisfaction (SS) and physical performance have been assessed in the management of numerous chronic diseases. In this study, the following tests and surveys were applied: (i) QOL questionnaire [Cystic Fibrosis Questionnaire (CFQ)]; (ii) SS questionnaire (SSQ) [female sexual quotient (FSQ) and male sexual quotient (MSQ)]; (iii) 6-minute walk test (6MWT). Spearman's correlation was used for comparison between the data; the Mann-Whitney test was applied to analyze the difference between genders. A total of 52 adult patients with CF were included in this study. There was a positive correlation between CFQ domains and SSQ questions. The CFQ showed a positive correlation with peripheral oxygen saturation of hemoglobin (SpO2) and the distance walked in the 6MWT, and a negative correlation with the Borg scale. The SSQ showed positive correlation with the distance walked and a negative correlation with the Borg scale. For some markers evaluated in the 6MWT, there was sometimes association with the evaluated domains and questions. Male patients showed better scores in the emotional CFQ domain, better performance in SSQ and physical performance. There was a correlation between CFQ, SSQ and 6MWT in CF. Finally; we believe that QOL surveys should assess the domain "sexuality" as well as physical performance tests. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  18. Perception of illness symptoms in patients with acute coronary syndrome: a need to improve.

    PubMed

    Ribeiro, Vânia; Melão, Filipa; Duarte Rodrigues, Joana; Machado Leite, Sérgio; Garcia, Raquel M; Dias, Paula; Maciel, Maria Júlia

    2014-09-01

    Interpretation of the symptoms of acute coronary syndrome (ACS) can influence the time of hospital admission and negatively affect patients' prognosis. We decided to explore illness perception and its predictors among patients with ACS. We conducted a retrospective analysis of all consecutive patients with ACS admitted to the cardiology department of a tertiary hospital between January and September 2011. Data were obtained from patients' medical records and telephone interviews. One hundred and eighty-six patients with ACS (mean age 64 ± 12 years; 70% male) were included. The majority (62.6%) had no perception of ACS until informed by their doctor. Only 26% of patients with ST-segment elevation myocardial infarction had perception of cardiac disease. Among those who had perception, 82.6% were men and 58% had a previous diagnosis of ischemic heart disease (IHD). Gender and previous diagnosis of IHD were independent predictors of ACS perception, with male gender and patients with previous IHD having greater illness perception. No association was found between ACS perception and age or residence area (rural vs. urban). The illness perception of ACS patients needs to be improved, independently of sociodemographic factors. An educational program for the general population, but particularly for women and individuals without a past history of IHD, focusing on the alert signs for ACS, may help to improve illness perception in this setting. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  19. Natural history of Brugada syndrome in a patient with congenital heart disease.

    PubMed

    Silva, Doroteia; Martins, Fernando Maymone; Cavaco, Diogo; Adragão, Pedro; Silva, Margarida Matos; Anjos, Rui; Ferreira, Álvaro; Gaspar, Isabel Mendes

    2015-01-01

    Risk stratification of sudden death in patients with Brugada syndrome (BrS) is a controversial issue, and there is currently no consensus on the best method. Examination of data from the natural history of the disease is of fundamental importance and may help to identify relatives at risk. At the same time, study of the genetic mutations responsible for the disease may also contribute to risk stratification of the syndrome, enabling identification of asymptomatic relatives carrying mutations. This paper presents the case of a young man, aged 26, monitored as a pediatric cardiology outpatient from birth for a simple structural heart defect not requiring surgery. Analysis of the evolution of the patient's electrocardiogram revealed the appearance, at the age of 20, of a pattern compatible with type I BrS. Following an episode of syncope and induction of polymorphic ventricular tachycardia in the electrophysiological study, a cardioverter-defibrillator was implanted. One year later, a single shock terminated an episode of ventricular fibrillation. A molecular study of the SCN5A gene identified a rare mutation, c.3622G>T (p.Glu1208X), recently described and associated with more severe phenotypes in patients with BrS, as in the case presented. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. Adaptations in limb muscle function following pulmonary rehabilitation in patients with COPD - a review.

    PubMed

    Nyberg, André; Carvalho, João; Bui, Kim-Ly; Saey, Didier; Maltais, François

    Even though chronic obstructive pulmonary disease (COPD) is primarily a disease of the respiratory system, limb muscle dysfunction characterized by muscle weakness, reduced muscle endurance and higher muscle fatigability, is a common secondary consequence and a major systemic manifestation of the disease. Muscle dysfunction is especially relevant in COPD because it is related to important clinical outcomes such as mortality, quality of life and exercise intolerance, independently of lung function impairment. Thus, improving muscle function is considered an important therapeutic goal in COPD management. Pulmonary rehabilitation (PR) is a multidisciplinary, evidence-based and comprehensive approach used to promote better self-management of the disease, minimize symptom burden, optimize functional status, and increase participation in activities of daily life. Exercise training, including cardiovascular and muscle exercises, is the cornerstone of PR and is considered the best available strategy to improve exercise tolerance and muscle function among patients with COPD. This paper addresses the various components of exercise training within PR used to improve limb muscle function in COPD, providing clinicians and health-care professionals with an overview and description of these various exercise modalities and of their effects on limb muscle function. Guidance and recommendations to help design optimal limb muscle training regimens for these patients are also presented. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  1. Validation of the Portuguese Severe Respiratory Insufficiency Questionnaire for home mechanically ventilated patients.

    PubMed

    Ribeiro, C; Ferreira, D; Conde, S; Oliveira, P; Windisch, W

    The aim of this study was to develop and validate the professional translation and cultural adaptation of the Portuguese Severe Respiratory Insufficiency (SRI) Questionnaire. The sample was composed of 93 patients (50 male patients, 53.8%) with a mean age of 66.3 years. The most frequent diagnostic groups were chronic obstructive pulmonary disease, obesity hypoventilation syndrome and restrictive chest wall disorders. The patients were asked to fill in both the SRI and SF-36 questionnaires. Factor analysis of the SRI questionnaire was performed leading to an explained variance of 73%, and resulted in 13 components. When analyzing the reliability, we obtained values for Cronbach's alpha above 0.70 for most subscales with the reliability of the summary scale being even higher (0.84). This professional translation and cultural adaptation of the Portuguese SRI Questionnaire has good psychometric properties which are similar, not only to the original, but also to other translations. These characteristics make this questionnaire applicable to the Portuguese population receiving home mechanical ventilation for severe respiratory insufficiency. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  2. Assessment of the factor structure and reliability of the Portuguese version of the General Health Questionnaire-28 among adults.

    PubMed

    De Almeida Vieira Monteiro, Ana Paula Teixeira

    2011-02-01

    The General Health Questionnaire (GHQ, Goldberg & Hillier, 1979 , Psychological Medicine, 9, 139-145) is a self-administered questionnaire used to measure non-psychotic psychiatric disorders. There is a study using a Portuguese version of this questionnaire (n = 60) including a group of inpatients with infectious diseases (Ribeiro & Antunes, 2003 , Revista Portuguesa de Psicossomática, 5(1), 37-45), but there are no larger studies in non-clinical Portuguese population. The primary aim of the study was to confirm the psychometric properties of the Portuguese version of the GHQ-28 among 171 Portuguese adults in non-clinical settings. The Portuguese version of the GHQ-28 was administered to 171 adult subjects of Portuguese general population. The Portuguese version of the GHQ-28 has an internally consistent measure Cronbach's α 0.922 for the GHQ-28 total scale. For the subscale somatic symptoms Cronbach's α was 0.825; for the subscale Anxiety/ Insomnia, Cronbach's α was 0.873; for the subscale Social dysfunction Cronbach's α was 0.873 and for the subscale Severe Depression was 0.838. Four factors were extracted using factor analysis: somatic symptoms (items 1-7); anxiety/insomnia (items 8-14); psychosocial dysfunction (items 15-21); and severe depression (items 22-28). The findings suggest that the GHQ-28 is a suitable screening instrument for adult Portuguese population in non-clinical settings.

  3. M-mode apical systolic excursion: A new and simple method to evaluate global left ventricular longitudinal strain.

    PubMed

    Amado, José; Islas, Fabián; de Isla, Islas Leopoldo Pérez; de Diego, Jose Juan Gómez; de Agustín, Alberto; García-Fernandez, Miguel Angel

    2015-09-01

    Since M-mode measurements can assess deformation of specific regions of the left ventricle, we hypothesized that M-mode measurements like M-mode apical systolic excursion (MMASE) and mitral annular plane systolic excursion (MAPSE) may be correlated with left ventricular longitudinal strain (LVLS). All subjects of the study underwent a full echocardiographic evaluation and MMASE and MAPSE measurement. Three-dimensional wall motion tracking (3D-WMT) was performed. Thirty-one patients were evaluated. Significant correlations between MAPSE and LVLS (-0.372; p=0.04) and between MMASE and LVLS (-0.398; p=0.027) were found. LVLS was linearly related to MAPSE and MMASE (in mm) as follows: ST=-10.6 -0.4 * MAPSE (r2=0.14) and ST=-13.1 -0.5 * MMASE (r2=0.16). Our results demonstrate that simpler and faster methods than strain based on complex speckle analysis can also have a role in predicting subclinical left ventricular systolic dysfunction. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. [Off-label prescription: practice and problems].

    PubMed

    Carneiro, António Vaz; Costa, João

    2013-09-01

    Approval of a drug for clinical use requires production of data on efficacy and safety through submission of results from randomized controlled trials (RCTs), in which the new molecule is usually compared with placebo (or an active comparator) for a set of outcomes that will serve as the basis for the drug's indications. These indications are crucial, because drugs are approved on the basis of their net clinical benefit for specific and well-defined diseases and--importantly--only for these. Once the drug is available for use in tens or hundreds of thousands of patients, physicians may realize that some medications can be effective in diseases for which they were not approved, i.e., no studies have been presented to the regulatory authorities, and therefore they are not formally approved for those indications. Convinced of the benefits for their patients, some physicians prescribe them for unapproved indications--off-label prescription. In this paper we discuss the prevalence of off-label prescription, and its advantages and problems. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  5. Predictors of pulmonary hypertension after intermediate-to-high risk pulmonary embolism.

    PubMed

    Barros, André; Baptista, Rui; Nogueira, Antony; Jorge, Elisabete; Teixeira, Rogério; Castro, Graça; Monteiro, Pedro; Providência, Luís Augusto

    2013-11-01

    Pulmonary embolism (PE) is a common cardiovascular emergency that, when combined with chronic thromboembolic pulmonary hypertension (PH), is associated with high mortality and morbidity. We aimed to determine the incidence of and predisposing factors for the development of PH after a PE episode. A retrospective study was conducted in 213 patients admitted to an intensive care unit with intermediate-to-high risk PE between 2000 and 2010. Clinical data at admission were collected and the incidence of PH as assessed by echocardiography (estimated pulmonary systolic artery pressure over 40 mmHg) was determined. Multivariate analysis was used to determine predictors of development of PH. PH was detected in 12.4% of patients after a mean follow-up of three years. Only age (hazard ratio [HR] 1.09, 95% confidence interval [CI] 1.02-1.20 per year; p=0.012) and body mass index (HR 1.19, 95% CI 1.04-1.36) per kg/m2, p=0.013) emerged as independent predictors of the development of this complication during follow-up. PH after PE was a relatively common complication in our series. We identified advanced age and increased body mass index as predisposing factors. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  6. Pro-inflammatory triggers in childhood obesity: correlation between leptin, adiponectin and high-sensitivity C-reactive protein in a group of obese Portuguese children.

    PubMed

    Pires, António; Martins, Paula; Pereira, Ana Margarida; Marinho, Joana; Vaz Silva, Patrícia; Marques, Margarida; Castela, Eduardo; Sena, Cristina; Seiça, Raquel

    2014-11-01

    Pediatric obesity is increasingly prevalent in the Portuguese population. Adipocyte dysfunction results in the expression of pro-inflammatory mediators that are responsible for the low-grade inflammatory process that characterizes obesity. The aim of this study was to investigate the relationship between markers of adiposity, inflammation and adipokines in a Portuguese obese pediatric population. One hundred and twenty children of both sexes, aged 6-17 years, were included in this study. The control group consisted of 41 healthy normal-weight children. The variables analyzed were age, gender, body mass index, waist circumference, fat mass percentage, high-sensitivity C-reactive protein (hs-CRP), leptin and adiponectin. There were significant differences between controls and obese children for all parameters analyzed. In the obese group, after controlling for age and gender, hs-CRP (p=0.041), adiponectin (p=0.019) and leptin (p<0.001) still showed significant statistical differences. A direct correlation was found between hs-CRP, leptin, body mass index and waist circumference, the strongest being with leptin (r=0.568; p<0.001). This trend remained statistically significant, regardless of gender or pubertal age. Considering the role of leptin, adiponectin and hs-CRP in the genesis of endothelial dysfunction, they may be used in clinical practice for risk stratification, as well as in the assessment of weight control programs. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. [Remote versus face-to-face monitoring for implantable cardiac devices: rationale and design of the PORTLink (PORTuguese Research on Telemonitoring with CareLink) trial].

    PubMed

    Oliveira, Mário; Fernandes, Milene; Primo, João; Reis, Hipólito; Nicola, Paulo

    2013-12-01

    With expanding indications for cardiac implantable electronic devices (CIEDs) capable of treating bradycardias, complex cardiac tachyarrhythmias and heart failure, the number of patients requiring regular long-term specialized care is growing rapidly. Currently, routine face-to-face follow-up consultations for patients with CIEDs are a significant burden on hospital services. Remote telemonitoring appears to offer a safe and effective alternative to conventional follow-up in this area. The Medtronic CareLink Network enables remote monitoring of CIED patients, and thus has the potential to improve the efficiency of medical care in this population. The objective of the PORTLink (PORTuguese Research on Telemonitoring with CareLink) multicenter randomized trial is to assess the safety, efficacy and costs of remote CIED monitoring compared to traditional face-to-face follow-up. It will evaluate aspects such as physicians' and patients' acceptance of and satisfaction with reviewing device data via the website, the complexity for troubleshooting calls to the support center, the use of emergency resources by symptomatic patients, the incidence of unscheduled consultations after remote interrogations, levels of anxiety, depression and quality of life, and the main resources used by the CareLink system. Approximately 200 patients will be randomized in up to five centers, with clinical follow-up of 12 months. Enrollment began in 2012 and is expected to be completed in early 2014. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Portuguese Society of Cardiothoracic and Vascular Surgery/Portuguese Society of Cardiology recommendations for waiting times for cardiac surgery.

    PubMed

    Neves, José; Pereira, Hélder; Sousa Uva, Miguel; Gavina, Cristina; Leite Moreira, Adelino; Loureiro, Maria José

    2015-11-01

    Appointed jointly by the Portuguese Society of Cardiothoracic and Vascular Surgery (SPCCTV) and the Portuguese Society of Cardiology (SPC), the Working Group on Waiting Times for Cardiac Surgery was established with the aim of developing practical recommendations for clinically acceptable waiting times for the three critical phases of the care of adults with heart disease who require surgery or other cardiological intervention: cardiology appointments; the diagnostic process; and invasive treatment. Cardiac surgery has specific characteristics that are not comparable to other surgical specialties. It is important to reduce maximum waiting times and to increase the efficacy of systems for patient monitoring and tracking. The information in this document is mainly based on available clinical information. The methodology used to establish the criteria was based on studies on the natural history of heart disease, clinical studies comparing medical treatment with intervention, retrospective and prospective analyses of patients on waiting lists, and the opinions of experts and working groups. Following the first step, represented by publication of this document, the SPCCTV and SPC, as the bodies best suited to oversee this process, are committed to working together to define operational strategies that will reconcile the clinical evidence with the actual situation and with available resources. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Sortilin and the risk of cardiovascular disease.

    PubMed

    Coutinho, Maria Francisca; Bourbon, Mafalda; Prata, Maria João; Alves, Sandra

    2013-10-01

    Plasma low-density lipoprotein cholesterol (LDL-C) levels are a key determinant of the risk of cardiovascular disease, which is why many studies have attempted to elucidate the pathways that regulate its metabolism. Novel latest-generation sequencing techniques have identified a strong association between the 1p13 locus and the risk of cardiovascular disease caused by changes in plasma LDL-C levels. As expected for a complex phenotype, the effects of variation in this locus are only moderate. Even so, knowledge of the association is of major importance, since it has unveiled a new metabolic pathway regulating plasma cholesterol levels. Crucial to this discovery was the work of three independent teams seeking to clarify the biological basis of this association, who succeeded in proving that SORT1, encoding sortilin, was the gene in the 1p13 locus involved in LDL metabolism. SORT1 was the first gene identified as determining plasma LDL levels to be mechanistically evaluated and, although the three teams used different, though appropriate, experimental methods, their results were in some ways contradictory. Here we review all the experiments that led to the identification of the new pathway connecting sortilin with plasma LDL levels and risk of myocardial infarction. The regulatory mechanism underlying this association remains unclear, but its discovery has paved the way for considering previously unsuspected therapeutic targets and approaches. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Correlation between C-Reactive Protein in Peripheral Vein and Coronary Sinus in Stable and Unstable Angina

    PubMed Central

    Leite, Weverton Ferreira; Ramires, José Antonio Franchini; Moreira, Luiz Felipe Pinho; Strunz, Célia Maria Cassaro; Mangione, José Armando

    2015-01-01

    Background High sensitivity C-reactive protein (hs-CRP) is commonly used in clinical practice to assess cardiovascular risk. However, a correlation has not yet been established between the absolute levels of peripheral and central hs-CRP. Objective To assess the correlation between serum hs-CRP levels (mg/L) in a peripheral vein in the left forearm (LFPV) with those in the coronary sinus (CS) of patients with coronary artery disease (CAD) and a diagnosis of stable angina (SA) or unstable angina (UA). Methods This observational, descriptive, and cross-sectional study was conducted at the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, and at the Hospital Beneficência Portuguesa de Sao Paulo, where CAD patients referred to the hospital for coronary angiography were evaluated. Results Forty patients with CAD (20 with SA and 20 with UA) were included in the study. Blood samples from LFPV and CS were collected before coronary angiography. Furthermore, analysis of the correlation between serum levels of hs-CRP in LFPV versus CS showed a strong linear correlation for both SA (r = 0.993, p < 0.001) and UA (r = 0.976, p < 0.001) and for the entire sample (r = 0.985, p < 0.001). Conclusion Our data suggest a strong linear correlation between hs-CRP levels in LFPV versus CS in patients with SA and UA. PMID:25494014

  11. Prolonged weaning: from the intensive care unit to home.

    PubMed

    Navalesi, P; Frigerio, P; Patzlaff, A; Häußermann, S; Henseke, P; Kubitschek, M

    2014-01-01

    Weaning is the process of withdrawing mechanical ventilation which starts with the first spontaneous breathing trial (SBT). Based on the degree of difficulty and duration, weaning is classified as simple, difficult and prolonged. Prolonged weaning, which includes patients who fail 3 SBTs or are still on mechanical ventilation 7 days after the first SBT, affects a relatively small fraction of mechanically ventilated ICU patients but these, however, requires disproportionate resources. There are several potential causes which can lead to prolonged weaning. It is nonetheless important to understand the problem from the point of view of each individual patient in order to adopt appropriate treatment and define precise prognosis. An otherwise stable patient who remains on mechanical ventilation will be considered for transfer to a specialized weaning unit (SWU). Though there is not a precise definition, SWU can be considered as highly specialized and protected environments for patients requiring mechanical ventilation despite resolution of the acute disorder. Proper staffing, well defined short-term and long-term goals, attention to psychological and social problems represent key determinants of SWU success. Some patients cannot be weaned, either partly or entirely, and may require long-term home mechanical ventilation. In these cases the logistics relating to caregivers and the equipment must be carefully considered and addressed. Copyright © 2014 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  12. Bambuina bambui: a new genus and species of cave cricket from Brazil (Orthoptera: Grylloidea: Phalangopsidae: Luzarinae).

    PubMed

    De Mello, Francisco De A G; Horta, Lília S; Bolfarini, Marcio P

    2013-01-03

    Bambuina bambui, um novo gênero e espécie de grilo falangopsídeo é descrito a partir de espécimes obtidos na Gruta do Centenário, uma caverna de quartzo localizada na Serra do Inficionado, um subconjunto de montanhas pertencentes ao complexo da Serra do Caraça no estado de Minas Gerais, Brasil.

  13. Communicating the Past via Translation: The Manipulation of History

    ERIC Educational Resources Information Center

    Valdeon, Roberto A.

    2011-01-01

    This paper examines the connection between translation and narratives of history, with particular attention to Howard Zinn's "A People's History of the United States" and its Spanish version, "La otra historia de los Estados Unidos". It is argued that translation interacts with history in many ways: translation is fundamental to history and, in…

  14. Educational Discourse in Spain during the Early Franco Regime (1936-1943): Toward a Genealogy of Doctrine and Concepts

    ERIC Educational Resources Information Center

    Laudo, Xavier; Vilanou, Conrad

    2015-01-01

    In this article an analysis is undertaken of Spanish educational discourse during the early years of the Franco regime, from the Civil War (1936-1939) to the establishment of the "Nuevo Estado" or New State (1939-1943), employing Reinhart Koselleck's principles of conceptual history. Without totally spurning the totalitarian and fascist…

  15. Simposio interamericano sobre administracion de la educacion (Inter-American Symposium on Educational Administration).

    ERIC Educational Resources Information Center

    Cespedes, Francisco S., Ed.

    The presidents and foreign ministers in Latin America recognize the importance of applying technology to school administration as the first step in any educational reform. In October 1968, the Organization of American States (OAS) [Organizacion de los Estados Americanos (OEA)], sponsored a symposium in Brasilia, Brazil, in cooperation with the…

  16. Building Intercultural Competence through Intercultural Competency Certification of Undergraduate Students

    ERIC Educational Resources Information Center

    Janeiro, Maria G. Fabregas; Fabre, Ricardo Lopez; Nuno de la Parra, Jose Pablo

    2014-01-01

    The Intercultural Competency Certificate (CCI in Spanish) designed for the Universidad Popular Autonoma del Estado de Puebla (UPAEP University) is a theory based comprehensive plan to develop undergraduate students' intercultural competence. This Certificate is based in the Developmental Model of Intercultural Sensitivity (DMIS) developed by…

  17. The Role of Religion in the Mexican Drug War

    DTIC Science & Technology

    2011-10-28

    folk heroes and false “saints” not part of any organized religion. 37 Presidencia de La Republica ...latino.foxnews.com/latino/news/2011/07/20/patterned-after- knights-templar-drug-cartel-issues-code-conduct/ Presidencia de La Republica , Estados Unidos

  18. Ensuring That Army Infrastructure Meets Strategic Needs

    DTIC Science & Technology

    2008-01-01

    sovereignty, territory , domestic population, and critical infrastructure against external threats from the air, land, or sea by foreign militaries or by... Desarrollo Sustentable del Estado de Sonora with support from Department of Defense Legacy Program, Agency and Institutional partners, April 2000. McCombs

  19. Educational Discourse in Spain during the Early Franco Regime (1936-1943): Toward a Genealogy of Doctrine and Concepts

    ERIC Educational Resources Information Center

    Laudo, Xavier; Vilanou, Conrad

    2015-01-01

    In this article an analysis is undertaken of Spanish educational discourse during the early years of the Franco regime, from the Civil War (1936-1939) to the establishment of the "Nuevo Estado" or New State (1939-1943), employing Reinhart Koselleck's principles of conceptual history. Without totally spurning the totalitarian and fascist…

  20. War and Peace in the Amazon: Strategic Implications for the United States and Latin America of the 1995 Ecuador-Peru War.

    DTIC Science & Technology

    1995-11-24

    reformist officer corps of the 1950s and 1960s--the founders of the modern Center of Higher Military Studies ( Centro de Altos Estudios Militares). In...Perez Concha, Ensayo Historico -Critico de las Relaciones Diplomaticas con los Estados Limitrofes, 2 vols., Quito: Banco Central del Ecuador, 1979

  1. A Comparative Analysis between the Portuguese Air Force and the United States Air Force Budgeting Processes

    DTIC Science & Technology

    1986-12-01

    pensions . 2. Current activities, including personnel support, feeding, consumables, utilities, and nonspecihed services. 3. Operational activities...1985. 15. Divisao de Planeamento, Planeamento Integrado, MFA 300-2, EM FA, 3 Div.. Lisboa, Jun 1984. 16. Estado Maior da Forca Aerea, Sistema de

  2. Design, Implementation and Evaluation of an Operating System for a Network of Transputers.

    DTIC Science & Technology

    1987-06-01

    Estado Maior da Armada Brazilian Naval Commission 4706 Wisconsin Ave., NW. Washington, DC 20016 14. Diretona de Ensino da .\\larinha Brazilian Naval...Instituto Mititar de Engenharia Praia Vermelha. Urca Rio de Janeiro, RJ CEP 20000, BRAZIL 18. Instituto Tecnoldgico da Aeronautica $5o Jose dos Campos. SP

  3. Building Intercultural Competence through Intercultural Competency Certification of Undergraduate Students

    ERIC Educational Resources Information Center

    Janeiro, Maria G. Fabregas; Fabre, Ricardo Lopez; Nuno de la Parra, Jose Pablo

    2014-01-01

    The Intercultural Competency Certificate (CCI in Spanish) designed for the Universidad Popular Autonoma del Estado de Puebla (UPAEP University) is a theory based comprehensive plan to develop undergraduate students' intercultural competence. This Certificate is based in the Developmental Model of Intercultural Sensitivity (DMIS) developed by…

  4. Developing Students' Autonomy and Self-Regulation through a Co-Teaching Research Methods Experience

    ERIC Educational Resources Information Center

    Fabregas Janeiro, Maria G.; Gaeta González, Martha L.

    2008-01-01

    The College of Human Sciences at Oklahoma State University (OSU) and Universidad Popular Autónoma del Estado de Puebla (UPAEP) decided to offer Pedagogy Doctoral students from Mexico a 3 week co-teaching research methods experience. Two professors, one from each institution (OSU and UPAEP), designed the syllabus to offer a co-teaching experience…

  5. Studies to Control Endemic Typhoid Fever in Chile

    DTIC Science & Technology

    1987-03-30

    practicao cuatro veces mis co paboc con mayor desarrllo, econ6anico y lecistopatfus en mujeres que en hcrnbre. baja inoidencia de infecciones entiricas...resto del pus. te hecho, unid a Is &ecuoncza de estados LAs c ocstectomnfas fueroms apmxixad portsdores ca los casoo do wlecistapatia, monte cuatro

  6. FOREIGN ASSISTANCE: Peru on Track for Free and Fair Elections but Faces Major Challenges

    DTIC Science & Technology

    2007-11-02

    Procesos Electorales, ONPE), and the National Registry of Identification and Civil Status (Registro Nacional de Identificacion y Estado Civil, RENIEC...organization Amount Technical assistance $3,298,438 Oficina Nacional de Procesos Electorales 1,520,000 International Foundation for...election-day, and post- election observation missions around the globe. Oficina Nacional de Procesos Electorales (ONPE) An autonomous Peruvian

  7. AGARD Flight Test Techniques Series. Volume 19. Simulation in Support of Flight Testing. (la Simulation pour le soutien des essais en vol)

    DTIC Science & Technology

    2000-09-01

    point where the amount of effort required to design, build, engine and spin chute . Many of the other cockpit functions and conduct V&V on the displays...HONGRIE PORTUGAL Directeur - Recherche et d~veloppement - Department for Scientific Estado Maior da Forga Afrea Communications et gestion de Analysis

  8. The Educational Narrativity in the First Period of Oliveira Salazar's Government. Women's Voices in the National Assembly (1935-1945)

    ERIC Educational Resources Information Center

    Adao, Aurea; Remedios, Maria Jose

    2005-01-01

    Oliveira Salazar's accession to the government followed the military coup of 1926, which put an end to the period of democratic republican life. The Constitution approved in 1933 defined the new regime, which came to be known as "Estado Novo". Ideologically sustained by an anti-liberal concept of Catholicism, this political regime would…

  9. Algunos Resumenes

    NASA Astrophysics Data System (ADS)

    1980-03-01

    En una sesion especial celebrada en Ginebra el dia 26 de marzo el Consejo de la ESO aeepto por unanimidad a Italia y Suiza eomo nuevos estados miembros de la organizaeion. Una vez que los proeedimientos necesarios para la ratifieaeion por las Camaras de ambos pafses hayan sido eoneluldos eon exito, podrfan ellos ser asoeiados efectivamente a prineipios dei ario 1981.

  10. DNA-based identification of Armillaria isolates from peach orchards in Mexico state

    Treesearch

    Ruben Damian Elias Roman; Ned B. Klopfenstein; Dionicio Alvarado Rosales; Mee-Sook Kim; Anna E. Case; Sara M. Ashiglar; John W. Hanna; Amy L. Ross-Davis; Remigio A. Guzman Plazola

    2012-01-01

    A collaborative project between the Programa de Fitopatología, Colegio de Postgraduados, Texcoco, Estado de Mexico and the USDA Forest Service - RMRS, Moscow Forest Pathology Laboratory has begun this year (2011) to assess which species of Armillaria are causing widespread and severe damage to the peach orchards from México state, Mexico. We are employing a DNA-based...

  11. Dicloruro de paraquat

    EPA Pesticide Factsheets

    El dicloruro de paraquat, comúnmente conocido como “paraquat,” es uno de los herbicidas registrados de mayor uso en los Estados Unidos. El paraquat también se conoce como Gramaxone (un producto popular de uso final

  12. Los LGBT y fumar | Smokefree Español

    Cancer.gov

    En Estados Unidos, las personas lesbianas, gays, bisexuales y transexuales (LGBT) tienen el doble de probabilidades de empezar a fumar que los heterosexuales. Sepa por qué los miembros de la comunidad LGBT fuman y aprenda estrategias para dejar de fumar definitivamente.

  13. JPRS Report, Nuclear Developments

    DTIC Science & Technology

    1991-05-31

    Minister Sergio Roberto Pinto Teixeira and Omar Gattas are Erman Gonzalez has announced that "all the installa- superintending director and commercial...purposes. Approached by ESTADO DE SAO PAULO, Jacques "It is important to retain the useful components, espe- Mercier, Arianespace representative in...according to Elebras superintending director Sergio Pinto Teixeira, the Foreign Affairs Ministry opposed The international consortium which Elebra

  14. The Educational Narrativity in the First Period of Oliveira Salazar's Government. Women's Voices in the National Assembly (1935-1945)

    ERIC Educational Resources Information Center

    Adao, Aurea; Remedios, Maria Jose

    2005-01-01

    Oliveira Salazar's accession to the government followed the military coup of 1926, which put an end to the period of democratic republican life. The Constitution approved in 1933 defined the new regime, which came to be known as "Estado Novo". Ideologically sustained by an anti-liberal concept of Catholicism, this political regime would…

  15. Significance of Hemispheric Security for Mexico

    DTIC Science & Technology

    2007-11-02

    Preservacion de la Paz en el Ambito Hemisferico y el Proceso en Torno al Nuevo Concepto de la Seguridad. Organizacion de los Estados Americanos, 56o... Desarrollo 2001-2006, (Mexico, D.F., July 2000), 25 49 Stephen J. Wagner, “The Mexican Military Approaches the 21st Century: Coping with a New World

  16. Computer-Mediated Communications for Distance Education and Training: Literature Review and International Resources

    DTIC Science & Technology

    1991-01-01

    Publishing Co., P.O. Box 25, Abingdon, Oxfordshire, OX14 3UE, UK. La Educacion: Revista Interamericana Desarrollo Educativo, Departamento de Asunto...Educativos, Organizacion de los Estados Americanos, Washington, DC 20006, USA. Lifelong Learning:, 1112-16 St. N.W., Ste. 420, Washington DC, 20036 USA

  17. Notes and Redescriptions of Some Anopheles Series Arribalzagia Holotypes (Diptera: Culicidae) in the British Museum (Natural History)

    DTIC Science & Technology

    1988-10-12

    Ev- ans La Cabrero Estado Carabobo 192 1 Dr. M Nunez Tovar”; “Holotype of Anopheles venezuelae Evans det. J . Chainey 1975.” Condition of specimen...Anophelines of the Amazon Med. Parasitol. 17: 101-l 11. Valley. Proc. Entomol. Sot. Wash. 35: 117-133. Reid, J . A. and K. L. Knight. 196 1. Classification

  18. Distribution and persistence of sterile screwworms (Diptera: Calliphoridae) released at the Panama-Colombia border

    USDA-ARS?s Scientific Manuscript database

    The sterile insect technique is currently used by the Comisión Panamá - Estados Unidos para la Erradicación y Prevención del Gusano Barrenador del Ganado (COPEG) to maintain a barrier at the border between Panama and Colombia that prevents screwworms, Cochliomyia hominivorax (Coquerel), from South A...

  19. [Incidence pityriasis rosea of Gibert in the Dermatology Service of the Hospital do Servidor Público in the state of São Paulo].

    PubMed

    de Souza Sittart, J A; Tayah, M; Soares, Z

    1984-01-01

    The authors present a retrospective study on the incidence of Pitiriase Rosea in the Dermatology Department of the Hospital do Servidor Público do Estado de São Paulo, covering a 17 years span. Figures concerning race, sex, age, mensal and anual incidence as well the distribution in the seasons of the year are analysed.

  20. El Programa Nacional de Estuarios (NEP)

    EPA Pesticide Factsheets

    Información general sobre el Programa Nacional de Estuarios (PNE, por sus siglas en inglés) establecido en el 1987 para restaurar y proteger los estuarios significativos para Estados Unidos, y sus territorios. La Agencia de Protección Ambiental de EE.UU.

  1. A New Species of Culex (Melanoconion) from Southern Brazil (Diptera: Culicidae)

    DTIC Science & Technology

    1979-01-01

    and W. L. Jakob3 ABSTRACT. Cdex (Mehnoconion) Zopesi, a new species from Municipio Iguape, Estado SBo Paulo, southern Brazil is recognized. The...CostZZo do Eugenho, Municipio Iguape, in SZo Paulo state, southern Brazil in February and March, 1976. This material was found to contain specimens of

  2. Algunos Resumenes

    NASA Astrophysics Data System (ADS)

    1982-09-01

    La agenda comienza con un resumen de parte dei Director General: estado de los proyectos de telescopios mas importantes, instrumentaci6n futura y otros asuntos. Luego el Director en Chile y el Jefe de TRS describen las condiciones presentes en que se encuentran los instrumentos, los problemas que han surgido y aquellos que se esperan. Luego estos puntos son disculidos por el Comite.

  3. The Significance of International Straits to Soviet Naval Operations

    DTIC Science & Technology

    1975-03-01

    capa - bility to produce sophisticated manufactured products. The Soviet Union is also rich in natural resources and, although the Soviets must import...Paria. Between Trinidad and Coast of 8 Venezuela. Between Aruba and Paraguana 15 Peninsula. Between Tierra del Fuego and Isla de 16 los Estados

  4. 77 FR 61051 - Additional Designations, Foreign Narcotics Kingpin Designation Act

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-05

    ..., Sinaloa, Mexico; Sevilla 1526 302 A, Fraccionamiento el Cid, Mazatlan, Sinaloa CP 82110, Mexico; Privada de San Jeronimo, San Jeronimo, Algodones, Baja California CP 21298, Mexico; Privada Puerta de Roble... Sayavedra, Atizapan de Zaragoza, Estado de Mexico CP 52930, Mexico; DOB 24 Oct 1962; POB Culiacan, Sinaloa...

  5. Communicating the Past via Translation: The Manipulation of History

    ERIC Educational Resources Information Center

    Valdeon, Roberto A.

    2011-01-01

    This paper examines the connection between translation and narratives of history, with particular attention to Howard Zinn's "A People's History of the United States" and its Spanish version, "La otra historia de los Estados Unidos". It is argued that translation interacts with history in many ways: translation is fundamental to history and, in…

  6. Handheld Metal Detectors: Nicaraguan Field Test Report

    DTIC Science & Technology

    2001-10-01

    Electronic Sensors Directorate (NVESD), the Organization of American States (OAS) ( Organizacion de los Estados Americanos [OEA]), the Assistance...manufacturer�s instructional manual , against known targets and soil types to optimize the detector sensitivity. Operators were instructed to operate...operating manual in the training/calibration area. Once calibration was completed, the operators were required to spend some time working with the

  7. Electrical Resistivity, Magnetic Susceptibility, Thermoelectric Power Heat Capacity of PtGa2

    DTIC Science & Technology

    1988-07-22

    Permanent address: Universidade Estadual de Campinas, Instituto de Fisica "Gleb Wataghin", Departamento de Fisica do Estado Solido e Ciencia dos...k.iliamns, in Proc. Intl. Conf. on Semiconductor and Integrated Circuit Technology, ,Yang Xiuying and Mo Bangxian, eds. (World Scientific Publ.Co

  8. Silicon Nanoclusters Embedded in SiO2 Studies by Raman Scattering

    DTIC Science & Technology

    2001-06-01

    Posgrado en Ingenieria , Facultad de Ingenieria , UAQ, Quer6taro, Qro., Mexico Abstract. Low concentration of nanometric sized particles produced by a ball...was partially supported by a CON- CYTEQ (Consejo de Ciencia y Tecnologia del Estado de Quer~taro) and CONACyT from Mexico. References [1] L. Rebohle, J

  9. Estación Astronómica Antártica José L. Sérsic: reporte 1996

    NASA Astrophysics Data System (ADS)

    Recabarren, P.; Mosconi, M.; Lazarte, G.; Cavarra, M.; Daguerre, F.

    Se presenta el estado de avance de los programas de observación en desarrollo en la estación ``J.~L.~SERSIC'', en Base Belgrano, a los 78 grados de latitud Sur. Se comentan algunas soluciones a los problemas que impone el riguroso ambiente polar en cuanto al funcionamiento y operación de los equipos.

  10. Gobierno Federal Contina Investigacin Cientfica Sobre Erupciones en Flint

    EPA Pesticide Factsheets

    Flint, MICH. (24 de marzo, 2016) - Los expertos federales, del estado y del condado de salud y agua entienden que los residentes de Flint están preocupados por la calidad general de su agua-tanto como para beber y para bañarse. En este momento, el an

  11. 16 CFR 455.5 - Spanish language sales.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... pueden darle a usted algunos derechos y hacer que el vendedor resuelva problemas graves que no fueron... implícitas” de acuerdo a la ley del estado pueden concederle derechos adicionales. EC29SE91.053 EC29SE91.054 ...

  12. Quest for Integrity: The Mexican-U.S. Drug Issue in the 1980s

    DTIC Science & Technology

    1992-01-01

    Garden City, New York, 1974. Sistema Nacional de Encuestas de Salud, Encuesta Nacional de Addiciones, Mexico, 1989. Stuart, Michael, "Narcotics: The...Torres (ed.), Interdependencia: ý Un enfoque util para el analisis de las relaciones Mexico-Estados Unidos? El Colegio de Mexico, Mexico, D.F., 1990a, pp

  13. La importancia de la protección de las playas

    EPA Pesticide Factsheets

    Las playas son una parte importante de la vida en Estados Unidos. Las playas ofrecen un sinnúmero de beneficios para el medio ambiente, actividades recreativas y la economía local. Aprenda la importancia de las playas y cómo protegerlas.

  14. Ciencia, Sociedad, Soluciones: Una Introduccion al USGS

    USGS Publications Warehouse

    ,

    2001-01-01

    El USGS sirve a la nacion de los Estados Unidos proveyendo informacion fidedigna para ? Describir y comprender la Tierra; ? Minimizar la perdida de vidas y propiedades por desastres naturales; ? Manejar los recursos hidrologicos, biologicos, energeticos y minerales; y ? Mejorar y proteger nuestra calidad de vida.

  15. White Book on National Defense (Republic of Argentina)

    DTIC Science & Technology

    1999-01-01

    MONUA: Mision de Observacion de Naciones Unidas en Angola. UN Observers Mission in Angola. MSU-SFOR: Unidad Multinacional especializada - Fuerza de...de Inteligencia del Estado. Central Intelligence Agency. SIN: Servicio de Inteligencia Naval. Naval Intelligence Service. SIJP: Sistema Nacional de...Jubilaciones y Pensiones. National Retirement and Pension System. XXVII SINAPA: Sistema Nacional de la Profesion Administrativa. National Civil Service

  16. Understanding Single-Stranded Telomere End Binding by an Essential Protein

    DTIC Science & Technology

    2000-08-01

    DOE Hydrogen Program and the Secretaria de Estado de Universidades, Investigaci6n y Desarrollo (Spain). MS, GC/MS, LC/MS Oral Session-Shane Needham... gradient and gel filtration experiments with chloroplast extract demonstrate that in folds, but is instead related to the toprim fold. Based on the structure

  17. Reacciones de intercambio de carga

    NASA Astrophysics Data System (ADS)

    Errea, L. F.

    Se discute la validez de diversas metodologías y su aplicación al estudio de procesos de intercambio de carga electrónico entre iones y blancos atómicos y moleculares. Para energías de impacto entre 0.05 y 5 eV / amu se emplea el método cuántico de la Coordenada de Reacción Común (CRC). A mayores energías, se utiliza el método semiclásico iconal con un desarrollo de la función de onda dinámica en estados moleculares adiabáticos, modificados con un factor de traslación común (FTC). Estos estados pueden obtenerse con cálculos ab initio o empleando potenciales modelo. Cuando la ionización compite con la transferencia de carga, la inclusión de pseudoestados en estos desarrollos permite calcular simultáneamente las secciones eficaces de ambos procesos. Otra técnica utilizada es el método estadístico CTMC. En el tratamiento de colisiones ión-molécula (diatómica) contrastamos la aplicabilidad de distintos métodos, desde la llamada aproximación Franck-Condon hasta un desarrollo en estados vibrónicos, pasando por la aproximación súbita vibro-rotacional, obteniéndose secciones eficaces de captura electrónica total y a estados individuales, así como secciones de excitación vibracional a estados ligados y del continuo (disociación). En todos los casos es necesario calcular superficies de energía y los correspondientes acoplamientos dinámicos entre los estados. La aplicación de estos métodos permite determinar el grado de contaminación de los haces por estados metaestables en un experimento dado, el cambio en los resultados con diferentes isótopos, la importancia de procesos de doble captura, seguida de explosión culombiana, todo ello con precisión comparable a la de medidas experimentales, para sistemas de interés en distintos tipos de plasmas.

  18. PubMed

    Sellés, Sergio; Fernández-Sáez, José; López-Lluch, Guillermo; Cejuela, Roberto

    2016-02-16

    El proceso de formación de futuros deportistas debe ser un trabajo estructurado y planificado para poder alcanzar el máximo nivel deportivo. Es fundamental en este periodo tener presentes los ritmos de desarrollo y maduración de los jóvenes deportistas para así adecuar las cargas de entrenamientos a sus estados evolutivos. El objetivo del estudio fue determinar y analizar la edad morfológica en nadadores y triatletas adolescentes, estableciendo diferencias entre su edad cronológica, grupos y género. A través del método antropométrico se determinó el estado de maduración biológica en un grupo de 37 deportistas jóvenes tecnificados. Los resultados muestran que la mayoría de la muestra (70,8%) se encuentra en un estado avanzado de desarrollo con respecto a su edad cronológica, siendo más notorio en el caso de los nadadores este estado de madurez avanzado. Tener una edad morfológica más avanzada respecto a su edad cronológica podría favorecer a los deportistas adolescentes a la hora de conseguir mejores marcas y resultados en las competiciones y de esta manera acceder con más facilidad a los programas de tecnificación. El índice de desarrollo corporal modificado (IDCm) se presenta como un método validado, fiable y no invasivo para tener presente el grado de desarrollo y maduración en la selección de talentos deportivos y adecuar las cargas de entrenamiento al estado evolutivo de los deportistas.

  19. [Diet and polymer standard vs. standard in the nutritional status of elderly patients with fragility].

    PubMed

    Luna-Ramos, Gissel Karelly; Pedraza-Zárate, Miguel Ángel; Franco-Álvarez, Nubia; González-Velázquez, Felipe

    2016-01-01

    Introducción: los pacientes geriátricos con fragilidad evidencian diferentes cambios fisiológicos, por lo que les son indicadas dietas poliméricas para mantener y/o modificar su estado nutricio. El objetivo de este artículo es demostrar el efecto al cambiar de una dieta estándar y polimérica a una dieta estándar en el estado nutricio en el paciente geriátrico con fragilidad. Métodos: ensayo clínico controlado aleatorizado en 23 pacientes geriátricos, de 70 años de edad o más, con fragilidad, en un periodo comprendido de julio a diciembre de 2014. Se determinó estado nutricional mediante la Mini Nutritional Asssessment y el índice de masa corporal. Análisis estadístico descriptivo, Chi cuadrada, t de Student y McNemar. Resultados: en el G1: fueron 12 pacientes y en el G2 11, se constató un cambio positivo en el G1 en el estado nutricional, siendo inicialmente de 14.00 (malnutrición) y al final de 22.75 (riesgo de desnutrición). De acuerdo al IMC (kg/m2) se evidenció al inicio, al 25 % de pacientes con desnutrición leve, pero los resultados finales arrojan cifras con un porcentaje nulo de pacientes desnutridos. Conclusiones: el consumo de dieta estándar y polimérica incrementa el peso corporal, IMC y el estado nutricio en pacientes geriátricos con fragilidad.

  20. Reporting on health-related research in two prestigious Brazilian newspapers

    PubMed Central

    Teixeira, Ricardo Afonso; Carlini, Marcela; de Carvalho Jatobá e Sousa, Arthur; Fernandes, Paula Teixeira; Camargo, Vera Regina Toledo; Vogt, Carlos; Li, Li Min

    2012-01-01

    OBJECTIVES: The dissemination of health-related news through newspapers can influence the behavior of patients and of health care providers. We conducted a study to analyze the characteristics of health-related research published by two leading Brazilian newspapers. METHOD: We retrospectively evaluated health-related news published in the electronic versions of the newspapers Folha de São Paulo and O Estado de São Paulo over a period of three months (July through September, 2009). Only articles mentioning medical research were included. The articles were categorized according to topic, source, study location and the nature of the headline. We also analyzed the presence of background information on the topic, citations of medical periodicals, national contextualization and references to products or companies. RESULTS: Scientific research articles corresponded to 57% and 20% of health-related articles published by Folha de São Paulo and O Estado de São Paulo, respectively. Folha de São Paulo published significantly more articles about national studies, and most articles were written by its own staff. In contrast, most articles in O Estado de São Paulo came from news agencies. Folha de São Paulo also better contextualized its reports for Brazilian society. O Estado de São Paulo tended to cite the name of the periodical in which the study was published more frequently, but their articles lacked national contextualization. CONCLUSION: The results showed a significant difference in the way in which the studied newspapers report on health-related research. Folha de São Paulo tends to write its own articles and more frequently publishes the results of national research, whereas O Estado de São Paulo publishes articles that originate in news agencies, most of which have little national contextualization. PMID:22473408

  1. [In Process Citation].

    PubMed

    Sznajder, Janusz; S Lefarska-Wasilewska, Marta; Kłek, Stanisław

    2016-02-16

    Objetivo: la esclerosis lateral amiotrófica (ELA) es una enfermedad crónica, neurodegenerativa que genera malnutrición. El objetivo principal de este estudio es analizar el impacto de la malnutrición en el curso de la enfermedad y la sobrevida a largo plazo.Materiales y métodos: se realizó un análisis retrospectivo de 48 pacientes (22 mujeres [45.83%] y 26 hombres [54.17%], con un promedio de edad de 66,2 [43-83]) del 2008 al 2014. El análisis del estado nutricional inicial se midió utilizando el índice de  masa corporal (IMC), el estado nutricional de acuerdo al NRS 2002, la valoración global subjetiva (VGS) y la concentración sérica de albúmina. Los pacientes se dividieron en dos grupos, dependiendo del estado nutricional en el que se encontraban: bien nutridos o malnutridos. Los grupos se crearon por  separado, lo que permitió un análisis comparativo adicional de las técnicas utilizadas para la evaluación del estado nutricional.Resultados: un estado nutricional adecuado se relaciona con mayor sobreviva a largo plazo (456 vs. 679 días, NRS 312 vs. 659 vs. 835 días, IMC respectivamente: 41, 541, 631 días, resultados estadísticamente significativos para NRS e IMC). Las concentraciones de albúmina no fueron un factor pronóstico, pero se observó mayor sobrevida si las concentraciones de albúmina incrementaban durante el tratamiento nutricional.Conclusiones: el estado nutricional inicial y la respuesta positiva a la alimentación enteral están asociados a mayor sobrevida en pacientes con ELA, razón por la cual, la terapia nutricional debe de iniciarse lo antes posible.

  2. [In Process Citation].

    PubMed

    López-López, Laura; Torres-Sánchez, Irene; González-Jiménez, Emilio; Díaz-Pelegrina, Ana; Merlos-Navarro, Silvia; Valenza, Marie Carmen

    2016-03-25

    Introducción: las alteraciones en el estado nutricional en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) son frecuentes. La sintomatología y la funcionalidad de estos enfermos pueden estar relacionadas con la nutrición, incrementando su gravedad en los sujetos con malnutrición. Objetivos: el objetivo de esta investigación fue profundizar sobre el perfil clínico del paciente con EPOC malnutrido y relacionar el estado nutricional con la funcionalidad y con los síntomas de estos pacientes. Métodos: se desarrolló un estudio observacional en pacientes con EPOC severo. Se valoró el estado de dependencia, la calidad de vida, las comorbilidades y la ansiedad y depresión. La función respiratoria se valoró con el volumen espiratorio forzado en el primer segundo y la escala de Borg modificada y el estado nutricional, con el Mini Nutritional Assessment. La sintomatología fue evaluada mediante el Leicester Cough Questionnaire y el London Chest Activity of Daily Living Scale. Resultados: 154 sujetos fueron incluidos en este estudio, 98 de ellos fueron varones. Un grupo de 71 sujetos mostraron malnutrición y un grupo de 83 sujetos un estado nutricional normal. La comparación entre los grupos mostró características clínicas significativamente diferen- tes (p < 0,05). El análisis mostró diferencias significativas en la disnea (p = 0,043), así como en las subescalas de funcionalidad relacionadas con sintomatología respiratoria autocuidado (p = 0,040), actividades de ocio (p = 0,019) y la puntuación total (p = 0,031), siendo peores en los sujetos malnutridos. Conclusión: los pacientes con EPOC malnutridos presentan más síntomas y peores niveles de funcionalidad que los pacientes con EPOC con estado nutricional normal.

  3. [European Portuguese EARS test battery adaptation].

    PubMed

    Alves, Marisa; Ramos, Daniela; Oliveira, Graça; Alves, Helena; Anderson, Ilona; Magalhães, Isabel; Martins, Jorge H; Simões, Margarida; Ferreira, Raquel; Fonseca, Rita; Andrade, Susana; Silva, Luís; Ribeiro, Carlos; Ferreira, Pedro Lopes

    2014-01-01

    Introdução: A utilização de instrumentos de avaliação em saúde adequados é fundamental na gestão da prestação de cuidados. A escassez, em Portugal, de instrumentos específicos para a avaliação do desempenho de crianças utilizadoras de implantes cocleares motivou o trabalho de tradução e de adaptação da bateria de testes EARS (Evaluation of Auditory Responses to Speech) para o português europeu. Esta bateria de testes é hoje um dos instrumentos mais comummente utilizados por equipas de (re)habilitação de crianças surdas com implantes cocleares em todo o mundo. O objetivo a atingir com a validação do EARS foi fornecer às equipas de (re)habilitação um instrumento que permita: (i) monitorizar a evolução individual da reabilitação; (ii) gerir um programa de (re)habilitação de acordo com resultados objetivos, comparáveis entre diferentes equipas de (re)habilitação; (iii) obter dados comparáveis comequipas internacionais; e (iv) melhorar a adesão e a motivação da família e restantes profissionais no ambulatório.Material e Métodos: No processo de tradução e de adaptação da bateria de testes, os procedimentos adotados foram os seguintes: (i) tradução da versão inglesa para português europeu por um tradutor profissional; (ii) revisão dessa tradução realizada por um painel de especialistas constituído por otorrinolaringologistas, terapeutas da fala e técnicos de audiologia; (iii) adaptação dos estímulos de teste pela equipa de terapeutas da fala; e (iv) nova revisão por parte do painel de especialistas.Resultados: São apresentados, para cada um dos instrumentos que compõem a bateria EARS, as adaptações introduzidas, conciliando as características e os objetivos originais dos instrumentos com as particularidades linguísticas e culturais da população portuguesa.Discussão: São discutidas as dificuldades encontradas durante o processo de tradução e de adaptação e as soluções adotadas. São feitas

  4. The Quebec Sleep Questionnaire on quality of life in patients with obstructive sleep apnea: translation into Portuguese and cross-cultural adaptation for use in Brazil.

    PubMed

    Melo, José Tavares de; Maurici, Rosemeri; Tavares, Michelle Gonçalves de Souza; Pizzichini, Marcia Margareth Menezes; Pizzichini, Emilio

    2017-07-31

    To translate the Quebec Sleep Questionnaire (QSQ), a specific instrument for the assessment of quality of life in patients with sleep obstructive apnea, into Portuguese and to create a version that is cross-culturally adapted for use in Brazil. The Portuguese-language version was developed according to a rigorous methodology, which included the following steps: preparation; translation from English into Portuguese in three versions; reconciliation to a single version; back-translation of that version into English; comparison and harmonization of the back-translation with the original version; review of the Portuguese-language version; cognitive debriefing; text review; and arrival at the final version. The Portuguese-language version of the QSQ for use in Brazil had a clarity score, as measured by cognitive debriefing, ranging from 0.81 to 0.99, demonstrating the consistency of translation and cross-cultural adaptation processes. The process of translating the QSQ into Portuguese and creating a version that is cross-culturally adapted for use in Brazil produced a valid instrument to assess the quality of life in patients with obstructive sleep apnea. Traduzir para a língua portuguesa e adaptar culturalmente para uso no Brasil o Quebec Sleep Questionnaire (QSQ), um instrumento específico para a avaliação da qualidade de vida em pacientes com apneia obstrutiva do sono. A versão em português foi desenvolvida obedecendo a uma criteriosa metodologia, que incluiu as seguintes fases: preparação; tradução do inglês para o português em três versões; conciliação para uma versão única em português; retradução da versão única para o inglês; comparação e harmonização da retradução com a versão original; revisão da versão em português; desdobramento cognitivo; revisão textual; e definição da versão final. A versão em português falado no Brasil do QSQ apresentou um índice de clareza, aferida pelo desdobramento cognitivo, que variou de 0

  5. Optimal cut-off value for homeostasis model assessment (HOMA) index of insulin-resistance in a population of patients admitted electively in a Portuguese cardiology ward.

    PubMed

    Timóteo, Ana Teresa; Miranda, Fernando; Carmo, Miguel Mota; Ferreira, Rui Cruz

    2014-01-01

    Introdução: A resistência à insulina é a chave fisiopatológica de explicação da Síndrome Metabólica. Apesar de claramente útil, o índice Homeostasis Model Assessment (uma medição da resistência à insulina) não tem sido aplicado sistematicamente na prática clínica. Uma das principais razões relaciona-se com a discrepância de valores limiares reportados em diferentes populações. Procurámos avaliar uma população portuguesa o valor limiar ideal e avaliar a sua relação com a Síndrome Metabólica. Material e Métodos: Selecionámos uma coorte de indivíduos admitidos eletivamente numa enfermaria de cardiologia com um IMC < 25 Kg/m2 e sem anomalias do metabolismo da glicose (glicémia em jejum < 100 mg/dL e sem diabetes). Utilizámos o percentil 90 da distribuição do índice Homeostasis Model Assessment para seleção do limiar adequado para resistência à insulina. Selecionouse também uma coorte de validação composta por 300 indivíduos, sem aplicação dos critérios de exclusão referidos anteriormente. Resultados: De uma população de 7 000 indivíduos e após aplicação dos critérios de exclusão, ficámos com 1 784 indivíduos para análise. O percentil 90 do índice foi 2,33. Na coorte de validação, aplicando esse limiar, 49,3% dos indivíduos apresentam resistência à insulina. Contudo, apenas 69,9% dos doentes com síndrome metabólica apresentam resistência à insulina com esse limiar. Por análise das curvas ROC, o limiar ideal para síndrome metabólica é 2,41. O índice Homeostasis Model Assessment correlacionou-se com o IMC (r = 0,371, p < 0,001) e é um preditor independente de presença de síndrome metabólica (OR 19,4, IC 95% 6,6 – 57,2, p < 0,001). Discussão: O nosso estudo mostrou que numa população portuguesa de doentes admitidos eletivamente numa enfermaria de cardiologia, o limiar pelo índice Homeostasis Model Assessment para resistência à insulina é 2,33 e para síndrome metabólica é 2

  6. Prognostic value of plasma neutrophil gelatinase-associated lipocalin in patients with heart failure.

    PubMed

    Villacorta, Humberto; Santos, Rochele Alberto Martins; Marroig, Marcelle Alves Baco; Pereira, Guilherme Pinella Guedes; Xavier, Analucia Rampazzo; Kanaan, Salim

    2015-01-01

    Neutrophil gelatinase-associated lipocalin (NGAL) is an early marker of kidney injury. We sought to assess the prognostic value of this biomarker in patients with stable chronic heart failure (HF). We studied 61 patients with chronic systolic HF who had been receiving optimal medical treatment for at least six months. Biomarkers were measured at baseline and included plasma NGAL, microalbuminuria, serum creatinine, and B-type natriuretic peptide (BNP). Estimated glomerular filtration rate (eGFR) was also calculated. Mean follow-up was 10.6±6.6 months. The primary endpoint was time to first cardiovascular event, defined as a combination of cardiovascular death, HF hospitalization or emergency department visit due to HF. Variables independently related to events were determined using a Cox proportional hazards model. Fifteen (24.6%) patients reached the primary endpoint. Patients with events were more likely to have worse renal function at baseline and also higher NGAL levels (median 316 [interquartile range 122-705] vs. 107 [78-170]; p=0.006). NGAL correlated significantly with creatinine (r=0.50; p<0.0001), albuminuria (r=0.33; p=0.008), and eGFR (r=-0.47; p=0.0001) but not with BNP (r=0.003; p=0.97). The best NGAL cutoff as determined by ROC curve analysis was 179 ng/ml. Event-free survival was lower in patients with NGAL above this cutoff. Variables independently related to events were NGAL (HR 1.0035, 95% CI 1.0019-1.0052; p<0.0001) and male gender (HR 5.9, 95% CI 1.22-28.6; p=0.028). NGAL correlated with other biomarkers of renal function but not with BNP and was independently associated with outcomes. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. Autonomic activity and biomarker behavior in supine position and after passive postural stress in different orthostatic intolerance syndromes.

    PubMed

    Freitas, João; Azevedo, Elsa; Santos, Rosa; Maciel, Maria Júlia; Rocha-Gonçalves, Francisco

    2015-09-01

    Orthostatic intolerance (OI) syndromes are a confusing topic and determining a specific diagnosis to achieve optimal treatment can be troublesome. We sought to assess biomarker, hemodynamic and autonomic variables in OI patients (autonomic dysfunction [AD], postural orthostatic tachycardia syndrome [POTS] and neurally mediated syncope [NMS]) and healthy controls during supine and head-up tilt position in order to achieve a better diagnosis. In response to head-up tilt, patients with AD presented a marked decrease in systolic blood pressure (SBP) (p=0.002), and a blunted increase in heart rate (HR) (p=0.04). Baroreceptor gain was almost absent in supine position and did not change in response to tilt. Patients with POTS had lower values of atrial natriuretic peptide (p=0.03) but similar neurohormonal biomarkers and hemodynamic and baroreceptor function in supine position compared to healthy subjects. However, in response to head-up tilting greater reductions in stroke volume (p=0.008) and baroreceptor gain (p=0.002) and greater rises in HR (p=0.001), total peripheral resistance (p=0.008), low frequency component of SBP variability (LF-SBP) (p=0.003) and plasma noradrenaline (p=0.03) were observed. Patients with NCS had similar biomarkers and autonomic indices to healthy subjects in supine position, but a larger decrease in baroreceptor gain (p=0.007) and a greater rise in LF-SBP (p=0.004) and plasma adrenaline (p=0.003) response to head-up tilting. Although different OI syndromes share similar symptoms, including blurred vision, syncope and dizziness particularly during orthostatism, they differ markedly regarding biochemical, autonomic and hemodynamic parameters. Assessment of these differences may be helpful for better diagnosis and management. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Procollagen type III amino terminal peptide and myocardial fibrosis: A study in hypertensive patients with and without left ventricular hypertrophy.

    PubMed

    dos Santos Moreira, Carlos; Serejo, Fátima; Alcântara, Paula; Ramalhinho, Vítor; Braz Nogueira, J

    2015-05-01

    An exaggerated accumulation of type I and type III fibrillar collagens occurs throughout the free wall and interventricular septum of patients with primary hypertension and left ventricular hypertrophy (LVH). In the present study the serum concentration of procollagen type III amino terminal peptide (PIIIP) was measured to determine the value of this peptide as a potential marker of ventricular fibrosis in hypertensive patients, particularly those with LVH. The study population consisted of patients with never-treated mild to moderate essential hypertension and 30 normotensive control subjects. Clinical, echocardiographic, electrocardiographic and biochemical parameters were assessed in all patients. Heart rate, body mass index and levels of blood pressure were increased in hypertensives, particularly those with LVH, compared to normotensive controls. Posterior wall thickness, left ventricular (LV) mass and LV mass index, and serum PIIIP concentration were also increased in hypertensives, with significant differences between the two hypertensive groups. The ratio between maximal early and late transmitral flow velocity measured during diastole was lower in hypertensives, particularly those with LVH, than in normotensive controls. The increase in PIIIP indicates that type III collagen synthesis increases in hypertensives, particularly those with LVH, implying that alterations in the heart in hypertension are the result not solely of hypertrophied LV muscle, but also of increased collagen deposition within the ventricular wall and around the coronary vessels. Thus, measurement of serum PIIIP could be a practical and useful tool in the non-invasive assessment of myocardial remodeling in hypertension. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Cost-effectiveness of rivaroxaban for stroke prevention in atrial fibrillation in the Portuguese setting.

    PubMed

    Morais, João; Aguiar, Carlos; McLeod, Euan; Chatzitheofilou, Ismini; Fonseca Santos, Isabel; Pereira, Sónia

    2014-09-01

    To project the long-term cost-effectiveness of treating non-valvular atrial fibrillation (AF) patients for stroke prevention with rivaroxaban compared to warfarin in Portugal. A Markov model was used that included health and treatment states describing the management and consequences of AF and its treatment. The model's time horizon was set at a patient's lifetime and each cycle at three months. The analysis was conducted from a societal perspective and a 5% discount rate was applied to both costs and outcomes. Treatment effect data were obtained from the pivotal phase III ROCKET AF trial. The model was also populated with utility values obtained from the literature and with cost data derived from official Portuguese sources. The outcomes of the model included life-years, quality-adjusted life-years (QALYs), incremental costs, and associated incremental cost-effectiveness ratios (ICERs). Extensive sensitivity analyses were undertaken to further assess the findings of the model. As there is evidence indicating underuse and underprescription of warfarin in Portugal, an additional analysis was performed using a mixed comparator composed of no treatment, aspirin, and warfarin, which better reflects real-world prescribing in Portugal. This cost-effectiveness analysis produced an ICER of €3895/QALY for the base-case analysis (vs. warfarin) and of €6697/QALY for the real-world prescribing analysis (vs. mixed comparator). The findings were robust when tested in sensitivity analyses. The results showed that rivaroxaban may be a cost-effective alternative compared with warfarin or real-world prescribing in Portugal. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Revisiting the slow force response: the role of the PKG signaling pathway in the normal and the ischemic heart.

    PubMed

    Castro-Ferreira, Ricardo; Neves, João Sérgio; Ladeiras-Lopes, Ricardo; Leite-Moreira, André M; Neiva-Sousa, Manuel; Almeida-Coelho, João; Ferreira-Martins, João; F Leite-Moreira, Adelino

    2014-09-01

    The myocardial response to acute stretch consists of a two-phase increase in contractility: an acute increase by the Frank-Starling mechanism and a gradual and time-dependent increase in force generated known as the slow force response (SFR). The SFR is actively modulated by different signaling pathways, but the role of protein kinase G (PKG) signaling is unknown. In this study we aim to characterize the role of the PKG signaling pathway in the SFR under normal and ischemic conditions. Rabbit papillary muscles were stretched from 92 to 100% of maximum length (Lmax) under basal conditions, in the absence (1) or presence of: a PKG agonist (2) and a PKG inhibitor (3); under ischemic conditions in the absence (4) or presence of: a PKG agonist (5); a nitric oxide (NO) donor (6) and a phosphodiesterase 5 (PDE5) inhibitor (7). Under normoxia, the SFR was significantly attenuated by inhibition of PKG and remained unaltered with PKG activation. Ischemia induced a progressive decrease in myocardial contractility after stretch. Neither the PKG agonist nor the NO donor altered the myocardial response to stretch under ischemic conditions. However, the use of a PDE5 inhibitor in ischemia partially reversed the progressive deterioration in contractility. PKG activity is essential for the SFR. During ischemia, a progressive decline in the force is observed in response to acute myocardial stretch. This dysfunctional response can be partially reversed by the use of PDE5 inhibitors. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. End-of-life care in COPD: a survey carried out with Portuguese pulmonologists.

    PubMed

    Gaspar, C; Alfarroba, S; Telo, L; Gomes, C; Bárbara, C

    2014-01-01

    End-of-life (EoL) care is a major component in the management of patients with advanced COPD. Patient-physician communication is essential in this process. To evaluate the practice of Portuguese Pulmonologists in EoL communication and palliative care in COPD. An on-line survey was sent to physicians affiliated to the Portuguese Pneumology Society. We obtained 136 answers from 464 eligible participants (29.3%). About half of the physicians reported that they have rarely introduced EoL discussions with their COPD patients (48.5%). Most had never/rarely suggested decision-making on the use of invasive mechanical ventilation (68.4%). Discussions were described as occurring mostly during/after a major exacerbation (53.7%). Only 37.5% of participants reported treating dyspnoea with opioids frequently/always. Only 9.6% stated that they never/rarely treated anxiety/depression. Most participants perceive the discussion of EoL issues as being difficult/very difficult (89.0%). The reasons most frequently given were feeling that patients were not prepared for this discussion (70.0%), fear of taking away a patient's hope (58.0%) and lack of training (51.0%). Patient and medical staff EoL communication in COPD is still not good enough. Training in this area and the creation of formal protocols to initiate EoL have been identified as major factors for improvement. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  12. Sarcomeric hypertrophic cardiomyopathy: genetic profile in a Portuguese population.

    PubMed

    Brito, Dulce; Miltenberger-Miltenyi, Gabriel; Vale Pereira, Sónia; Silva, Doroteia; Diogo, António Nunes; Madeira, Hugo

    2012-09-01

    Sarcomeric hypertrophic cardiomyopathy has heterogeneous phenotypic expressions, of which sudden cardiac death is the most feared. A genetic diagnosis is essential to identify subjects at risk in each family. The spectrum of disease-causing mutations in the Portuguese population is unknown. Seventy-seven unrelated probands with hypertrophic cardiomyopathy were systematically screened for mutations by PCR and sequencing of five sarcomeric genes: MYBPC3, MYH7, TNNT2, TNNI3 and MYL2. Familial cosegregation analysis was performed in most patients. Thirty-four different mutations were identified in 41 (53%) index patients, 71% with familial hypertrophic cardiomyopathy. The most frequently involved gene was MYBPC3 (66%) with 22 different mutations (8 novel) in 27 patients, followed by MYH7 (22%), TNNT2 (12%) and TNNI3 (2.6%). In three patients (7%), two mutations were found in MYBPC3 and/or MYH7. Additionally, 276 relatives were screened, leading to the identification of a mean of three other affected relatives for each pedigree with the familial form of the disease. Disease-associated mutations were identified mostly in familial hypertrophic cardiomyopathy, corroborating the idea that rarely studied genes may be implicated in sporadic forms. Private mutations are the rule, MYBPC3 being the most commonly involved gene. Mutations in MYBPC3 and MYH7 accounted for most cases of sarcomere-related disease. Multiple mutations in these genes may occur, which highlights the importance of screening both. The detection of novel mutations strongly suggests that all coding regions should be systematically screened. Genotyping in hypertrophic cardiomyopathy enables a more precise diagnosis of the disease, with implications for risk stratification and genetic counseling. Copyright © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Percutaneous patent foramen ovale closure: the Paradoxical Cerebral Embolism Prevention Registry.

    PubMed

    Paiva, Luís; Dinis, Paulo; Providência, Rui; Costa, Marco; Margalho, Susana; Goncalves, Lino

    2015-03-01

    The natural history and therapeutic interventions for secondary prevention after a cerebrovascular event in patients with patent foramen ovale (PFO) are not yet established. This study aims to assess the safety and efficacy of percutaneous PFO closure in a population of patients with ischemic cerebrovascular disease of unknown etiology. This prospective observational study included patients with a history of cryptogenic transient ischemic attack (TIA) or stroke who underwent percutaneous PFO closure. The effectiveness of the device for the secondary prevention of TIA or stroke was assessed by comparing observed events in the sample with expected events for this clinical setting. The sample included 193 cases of percutaneous PFO closure (age 46.4 ± 13.1 years, 62.2% female) with a mean follow-up of 4.3 ± 2.2 years, corresponding to a total exposure to ischemic events of 542 patient-years. The high-risk characteristics of the PFO were assessed prior to device implantation. There were seven primary endpoint events during follow-up (1.3 per 100 patient-years), corresponding to a relative risk reduction of 68.2% in recurrent TIA or stroke compared to medical therapy alone. The procedure was associated with a low rate of device- or intervention-related complications (1.5%). In this long-term registry, percutaneous PFO closure was shown to be a safe and effective therapy for the secondary prevention of cryptogenic stroke or TIA. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  14. Remote magnetic navigation for ablation of typical atrial flutter: Long-term results.

    PubMed

    Parreira, Leonor; Cavaco, Diogo; Carmo, Pedro; Reis-Santos, Katya; Quaresma, Rita; Teixeira, Tiago; Marques, Marta; Adragão, Pedro

    2014-12-01

    Remote magnetic navigation has proved to be effective in the ablation of most supraventricular and ventricular arrhythmias. Initial studies reported worse results with this system compared to conventional ablation for atrial flutter. The aim of this study was to assess the acute and long-term success of atrial flutter ablation with remote magnetic navigation and to retrospectively compare the results obtained with an 8-mm tip catheter versus an irrigated catheter. We studied 38 consecutive patients, mean age 61 ± 15 years, 28 male, who underwent ablation of typical atrial flutter with the Niobe II remote magnetic navigation system (Stereotaxis). Ablation was performed with an 8-mm tip catheter in 17 patients and with an irrigated-tip catheter in 21 patients. Acute success was defined as the presence of bidirectional isthmus block, and long-term success as absence of symptoms and atrial flutter during Holter monitoring. Bidirectional isthmus block was achieved in 37 patients (97%), and the success rate was similar in both groups. Total procedure time was not significantly different between the groups but fluoroscopy time was shorter in the irrigated tip group (13.4 ± 3.7 min vs. 6 ± 4.4 min; p<0.01). The number of applications and total radiofrequency time did not differ. There were no complications. During a follow-up of 32 ± 19 months there were two relapses, one in each group. The Niobe II remote control system for ablation of typical atrial flutter is safe and effective in both the short and long term. The 8-mm and irrigated-tip catheters showed similar safety and efficacy. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay.

    PubMed

    Souza Possa, S; Braga Amador, C; Meira Costa, A; Takahama Sakamoto, E; Seiko Kondo, C; Maida Vasconcellos, A L; Moran de Brito, C M; Pereira Yamaguti, W

    2014-01-01

    The aim of this study was to evaluate the effectiveness of implementing a physical therapy guideline for patients undergoing upper abdominal surgery (UAS) in reducing the incidence of atelectasis and length of hospital stay in the postoperative period. A "before and after" study design with historical control was used. The "before" period included consecutive patients who underwent UAS before guideline implementation (intervention). The "after" period included consecutive patients after guideline implementation. Patients in the pre-intervention period were submitted to a program of physical therapy in which the treatment planning was based on the individual experience of each professional. On the other hand, patients who were included in the post-intervention period underwent a standardized program of physical therapy with a focus on the use of additional strategies (EPAP, incentive spirometry and early mobilization). There was a significant increase in the use of incentive spirometry and positive expiratory airway pressure after guideline implementation. Moreover, it was observed that early ambulation occurred in all patients in the post-intervention period. No patient who adhered totally to the guideline in the post-intervention period developed atelectasis. Individuals in the post-intervention period presented a shorter length of hospital stay (9.2±4.1 days) compared to patients in the pre-intervention period (12.1±8.3 days) (p<0.05). The implementation of a physical therapy guideline for patients undergoing UAS resulted in reduced incidence of atelectasis and reduction in length of hospital stay in the postoperative period. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  16. The role of physiotherapy in patients undergoing pulmonary surgery for lung cancer. A literature review.

    PubMed

    Kendall, F; Abreu, P; Pinho, P; Oliveira, J; Bastos, P

    2017-06-13

    This review aims to appraise the role of physiotherapy care in patients submitted to pulmonary surgery, in preoperative, perioperative, and postoperative phases. Pulmonary surgery is the gold standard treatment for patients with lung cancer if it is completely resectable. However, the major impairments and complications induced by surgery are well known. Physiotherapy has been regularly used both in the preparation of the surgical candidates; in their functional recovery in the immediate postoperative period, and in the medium/long term but there is a lack of concise evidence-based recommendations. Therefore, the aim of this review is to appraise the literature about the role of physiotherapy interventions in patients undergoing lung surgery for lung cancer, in preoperative, perioperative, postoperative and maintenance stages, to the recovery and well-being, regardless of the extent of surgical approach. In conclusion, physiotherapy programs should be individually designed, and the goals established according to surgery timings, and according to each subject's needs. It can also be concluded that in the preoperative phase, the main goals are to avoid postoperative pulmonary complications and reduce the length of hospital stay, and the therapeutic targets are respiratory muscle training, bronchial hygiene and exercise training. For the perioperative period, breathing exercises for pulmonary expansion and bronchial hygiene, as well as early mobilization and deambulation, postural correction and shoulder range of motion activities, should be added. Finally, it can be concluded that in the postoperative phase exercise training should be maintained, and adoption of healthy life-style behaviours must be encouraged. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  17. The use of reperfusion and revascularization procedures in acute coronary syndrome in Portugal: a systematic review.

    PubMed

    Lopes-Conceição, Luísa; Pereira, Marta; Araújo, Carla; Laszczýnska, Olga; Lunet, Nuno; Azevedo, Ana

    2014-11-01

    Reperfusion and revascularization therapies play an important role in the management of coronary heart disease and have contributed to decreases in case fatality rates. We aimed to describe the use of these therapies for the treatment of acute coronary syndrome (ACS) patients over time in Portugal. PubMed was searched in July 2012. The proportion of patients treated with fibrinolysis, primary percutaneous coronary intervention (PCI), any PCI and coronary artery bypass grafting (CABG) was described according to type of ACS: STEMI (≥90% patients with ST-segment elevation or Q-wave myocardial infarction), NSTE-ACS (≥90% patients with non-ST-segment elevation ACS) and mixed ACS (all others). We identified 41 eligible studies, published between 1989 and 2011. Twenty-eight reported on samples considered representative of ACS patients treated in Portugal. The small number of estimates of the use of each treatment in STEMI and NSTE-ACS patients precluded identification of any time trend. In the last 20 years, the proportion of mixed ACS patients treated with fibrinolysis decreased and the use of PCI increased, while the use of CABG did not change. The general pattern of the use of reperfusion and revascularization is in accordance with that reported in other developed countries, reflecting a favorable trend in the quality of care of ACS patients. The relatively small number of estimates on the same procedure in comparable patients limits the generalizability of the conclusions, and highlights the need for systematic approaches to monitor the use of treatments over time. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  18. Cardiorenal syndrome in acute heart failure: a vicious cycle?

    PubMed

    Caetano, Francisca; Barra, Sérgio; Faustino, Ana; Botelho, Ana; Mota, Paula; Costa, Marco; Leitão Marques, António

    2014-03-01

    Worsening renal function has an unquestionably negative impact on prognosis in patients with acute heart failure (HF). In Portugal there is little information about the importance of this entity in HF patients admitted to hospital. The objective of this work was to assess the prevalence of cardiorenal syndrome and to identify its key predictors and consequences in patients admitted for acute HF. This was a retrospective study of 155 patients admitted for acute HF. Cardiorenal syndrome was defined as an increase in serum creatinine of ≥26.5 μmol/l. Clinical, laboratory and echocardiographic parameters were analyzed and compared. Mortality was assessed at 30 and 90 days. Cardiorenal syndrome occurred in 46 patients (29.7%), 5.4 ± 4.4 days after admission; 66.7% (n=24) did not recover baseline creatinine levels. The factors associated with cardiorenal syndrome were older age, chronic renal failure, moderate to severe mitral regurgitation, higher admission blood urea nitrogen, creatinine and troponin I, and lower glomerular filtration rate. Patients who developed cardiorenal syndrome had longer hospital stay, were treated with higher daily doses of intravenous furosemide, and more often required inotropic support and renal replacement therapy. They had higher in-hospital and 30-day mortality, and multivariate analysis identified cardiorenal syndrome as an independent predictor of in-hospital mortality. Renal dysfunction is common in acute HF patients, with a negative impact on prognosis, which highlights the importance of preventing kidney damage through the use of new therapeutic strategies and identification of novel biomarkers. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  19. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome.

    PubMed

    Soylu, Korhan; Gedikli, Ömer; Dagasan, Göksel; Aydin, Ertan; Aksan, Gökhan; Nar, Gökay; İnci, Sinan; Yilmaz, Özcan

    2015-01-01

    Inflammatory mechanisms are known to play an important role in coronary artery disease. The present study aimed to investigate the importance of the neutrophil-to-lymphocyte ratio (NLR) in terms of in-hospital mortality and its association with currently used risk scores in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Three hundred and seventeen patients with NSTE-ACS were included. The patients were divided into tertiles according to their NLR values (NLR <2.6, NLR=2.6-4.5, and NLR >4.5). Clinical and angiographic risk was evaluated by the SYNTAX and GRACE risk scores. The GRACE risk score was significantly higher in the group with high NLR values compared to those with moderate or low NLR (161.5±40.3, 130.5±32.3, and 123.9±34.3, respectively, p<0.001). Similarly, the SYNTAX score was significantly higher in the group with high NLR values (20.4±10.1, 15.5±10.5, and 13.4±7.8, respectively, p=0.003). Moreover, both GRACE (r=0.457, p<0.001) and SYNTAX scores (r=0.253, p=0.001) showed a significant positive correlation with NLR. NLR has been found to be correlated with clinical and angiographic risk scores. Low NLR might be a good predictor for low in-hospital mortality and simple coronary anatomy in NSTE-ACS patients. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. Characterization of acute heart failure hospitalizations in a Portuguese cardiology department.

    PubMed

    Pinho-Gomes, Ana Catarina; Silva Cardoso, José; Azevedo, Luís Filipe; Almeida, Rui; Pinho, Teresa; Maciel, Maria Júlia

    2013-01-01

    We describe the clinical characteristics, management and outcomes of patients hospitalized with acute heart failure in a south-west European cardiology department. We sought to identify the determinants of length of stay and heart failure rehospitalization or death during a 12-month follow-up period. This was a retrospective cohort study including all patients admitted during 2010 with a primary or secondary diagnosis of acute heart failure. Death and readmission were followed through 2011. Of the 924 patients admitted, 201 (21%) had acute heart failure, 107 (53%) of whom had new-onset acute heart failure. The main precipitating factors were acute coronary syndrome (63%) and arrhythmia (14%). The most frequent clinical presentations were heart failure after acute coronary syndrome (63%), chronic decompensated heart failure (47%) and acute pulmonary edema (21%). On admission 73% had left ventricular ejection fraction <50%. Median length of stay was 11 days and in-hospital mortality was 5.5%. The rehospitalization rate was 21% and 24% at six and 12 months, respectively. All-cause mortality was 16% at 12 months. The independent predictors of rehospitalization or death were heart failure hospitalization during the previous year (Hazard ratio - HR - 3.177), serum sodium <135mmol/l on admission (HR 1.995) and atrial fibrillation (HR 1.791). Reduced left ventricular ejection fraction was associated with a lower risk of rehospitalization or death (HR 0.518). Our patients more often presented new-onset acute heart failure, due to an acute coronary syndrome, with reduced left ventricular ejection fraction. Several predictive factors of death or rehospitalization were identified that may help to select high-risk patients to be followed in a heart failure management program after discharge. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Acute kidney injury in acute coronary syndromes - An important multifactorial consequence.

    PubMed

    Neves, David; Belo, Adriana; Damásio, Ana Filipa; Carvalho, João; Santos, Ana Rita; Piçarra, Bruno; Aguiar, José

    2016-01-01

    Acute kidney injury (AKI) is a pathological phenomenon with a negative impact on outcomes in different clinical scenarios. Its mechanism in acute coronary syndrome (ACS) is not completely understood, and measures to prevent it are not uniform. We set out to study the incidence, clinical relevance, predictors and possible implications for patient management of AKI in ACS. Using data from a multicenter national registry on ACS, we retrospectively analyzed predictors of AKI and its impact on outcomes (in-hospital complications and one-year mortality). All ACS types were included. AKI was defined as an increase in serum creatinine of ≥0.3 mg/dl (≥26.4 μmol/l) and/or by ≥1.5 times baseline. A total of 7808 ACS patients were included in the analysis, 1369 (17.5%) of whom developed AKI. AKI was shown to be an independent predictor of in-hospital major bleeding (odds ratio [OR] 2.09; 95% confidence interval [CI] 1.19-3.64; p=0.01), mortality (OR 4.72; 95% CI 2.94-7.56; p<0.001) and one-year mortality (hazard ratio 2.01; 95% CI 1.51-2.68; p<0.001). The incidence of AKI was associated with older age, history of hypertension, renal failure and stroke/transient ischemic attack, Killip class >1 on admission and left ventricular ejection fraction <50%. Performance of coronary angiography or angioplasty were not associated with AKI. Diuretics during admission were predictors of AKI only in patients in Killip class 1. AKI is an important finding in ACS, with a significant impact on hard clinical endpoints such as in-hospital and one-year mortality. It is associated with easily identifiable clinical factors and an invasive strategy does not increase its incidence. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Validity of the updated GRACE risk predictor (version 2.0) in patients with non-ST-elevation acute coronary syndrome.

    PubMed

    Akyuz, Sukru; Yazici, Selcuk; Bozbeyoglu, Emrah; Onuk, Tolga; Yildirimturk, Ozlem; Karacimen, Denizhan; Hayiroglu, Mert Ilker; Erdogan, Guney; Oner, Abdullah Orcun; Calik, Ali Nazmi; Cagdas, Metin; Cam, Nese

    2016-01-01

    A new version of the Global Registry of Acute Coronary Events (GRACE) risk score (version 2.0) has been released recently. The purpose of the present study was to assess the validity of GRACE 2.0 for in-hospital and 1-year mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. The prospective cohort comprised 396 consecutive NSTE-ACS patients admitted to a tertiary hospital between May 2012 and January 2013. The main outcome measure was the discrimination and calibration performance of GRACE 2.0, which were evaluated with the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test, respectively. In-hospital and 1-year mortality were 2% (8/396) and 12.4% (48/388), respectively. The discrimination performance was inadequate (AUC=0.62) for predicting in-hospital mortality for the overall cohort. Also, the calibration performance for in-hospital mortality could not be evaluated due to the low number of patients who died. At one year, the Hosmer-Lemeshow p-values for all subgroups were >0.05, suggesting a good model fit, and the discrimination performance was good (AUC=0.77) for the overall cohort, driven mainly by better accuracy for low-risk patients. In a contemporary cohort of NSTE-ACS patients, GRACE 2.0 was valid for 1-year mortality assessment. Its value for in-hospital mortality requires validation in a larger cohort. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. Congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery: an interesting case report.

    PubMed

    Turker, Yasin; Tibilli, Hakan

    2014-01-01

    Intercoronary communication is a very rare coronary artery anomaly. It is defined as an open-ended circulation with bidirectional blood flow between two coronary arteries. Coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or major vessel. A 62-year-old man was admitted to our hospital with sudden development of general weakness, dizziness and a sensation of compression in his chest. At presentation his blood pressure was 80/40 mmHg and heart rate was 65 beats/min. The ECG revealed sinus rhythm and 1-2 mm ST elevation in the anterior leads. The patient was taken to the catheterization laboratory for percutaneous coronary intervention. The left main and left circumflex coronary arteries were normal. Coronary angiography showed a communication between the left main and the diagonal branch of the left anterior descending and a fistula between the intercoronary connection and the left atrium. The other coronary arteries were normal. Laboratory test results, including cardiac troponin I and creatine kinase-MB levels, were normal. The angina symptoms disappeared and the ST elevation resolved within four hours. We report an interesting case of congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery presenting as an acute coronary syndrome. To the best of our knowledge, this is the first case in the literature involving a coronary artery fistula in an intercoronary communication. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. Impact of atrial fibrillation type during acute coronary syndromes: Clinical features and prognosis.

    PubMed

    Braga, Carlos Galvão; Ramos, Vítor; Martins, Juliana; Arantes, Carina; Abreu, Glória; Vieira, Catarina; Salgado, Alberto; Gaspar, António; Azevedo, Pedro; Álvares Pereira, Miguel; Magalhães, Sónia; Marques, Jorge

    2015-06-01

    Atrial fibrillation (AF) is widely recognized as an adverse prognostic factor during acute myocardial infarction, although the impact of AF type - new-onset (nAF) or pre-existing (pAF) - is still controversial. To identify the clinical differences and prognosis of nAF and pAF during acute coronary syndromes (ACS). We performed a retrospective observational cohort study including 1373 consecutive patients (mean age 64 years, 77.3% male) admitted to a single center over a three-year period, with a six-month follow-up. AF rhythm was identified in 14.5% patients, of whom 71.4% presented nAF and 28.6% pAF. When AF types were compared, patients with nAF more frequently presented with ST-elevation ACS (p=0.003). Patients with pAF, in turn, were older (p=0.032), had greater left atrial diameter (p=0.001) and were less likely to have significant coronary lesions (p=0.034). Regarding therapeutic strategy, nAF patients were more often treated by rhythm control during hospital stay (p<0.001) and were less often anticoagulated at discharge (p=0.001). Compared with the population without AF, nAF was a predictor of death during hospital stay in univariate (p<0.001) and multivariate analysis (OR 2.67, p=0.047), but pAF was not. During follow-up, pAF was associated with higher mortality (p=0.014), while nAF patients presented only a trend towards worse prognosis. AF during the acute phase of ACS appears to have a negative prognostic impact only in patients with nAF and not in those with pAF. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  5. Clinical characteristics and in-hospital outcome of patients with acute coronary syndromes and systemic lupus erythematosus.

    PubMed

    de Matos Soeiro, Alexandre; de Almeida Soeiro, Maria Carolina Feres; de Oliveira, Mucio Tavares; Serrano, Carlos Viente

    2014-11-01

    Due to the chronic inflammation associated with systemic lupus erythematosus (SLE), patients develop premature atherosclerosis and the disease is a risk factor for acute myocardial infarction. The best interventional treatment for acute coronary syndrome (ACS) in these patients is unclear. The objective of this study is to describe the baseline characteristics, clinical manifestations, treatment and in-hospital outcome of patients with SLE and ACS. Eleven SLE patients with ACS were analyzed retrospectively between 2004 and 2011. The following data were obtained: age, gender, clinical and electrocardiographic characteristics, Killip class, risk factors for ACS, myocardial necrosis markers (CK-MB and troponin), creatinine clearance, left ventricular ejection fraction, inflammatory markers (C-reactive protein and erythrocyte sedimentation rate), drugs used during hospital stay, treatment (medical, percutaneous or surgical) and in-hospital outcome. The statistical analysis is presented in percentages and absolute values. Ten of the patients (91%) were women. The median age was 47 years. Typical precordial pain was present in 91%. Around 73% had positive erythrocyte sedimentation rate. The vessel most often affected was the anterior descending artery, in 73%. One patient underwent coronary artery bypass grafting, seven underwent percutaneous coronary intervention with bare-metal stents and three were treated medically. In-hospital mortality was 18%. Despite the small number of patients, our findings were similar to those in the literature, showing coronary artery disease in young people with SLE due to premature atherosclerosis and a high mortality rate. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  6. Use of drug-eluting versus bare-metal stents after an acute coronary syndrome in Portugal: the EURHOBOP study.

    PubMed

    Barros, Vítor; Pereira, Marta; Araújo, Carla; Braga, Pedro; Azevedo, Ana

    2015-01-01

    The interventional cardiologist chooses a specific stent type based on the risk-benefit profile for each case. In general, drug-eluting stents should be considered in all clinical conditions, except if there are concerns or contraindications for prolonged dual antiplatelet therapy. The aim of this work was to describe the use of bare-metal vs. drug-eluting stents in patients undergoing percutaneous coronary intervention (PCI) after an acute coronary syndrome in Portuguese hospitals, according to patients' demographic and clinical characteristics and institutional characteristics. Within the EURopean Hospital Benchmarking Processes (EURHOBOP) study, we retrospectively assessed 3009 consecutive patients in 10 Portuguese hospitals in 2009. Only patients with stents implanted during PCI (n=1194) were analyzed. A total of 425 patients (36%) received a bare-metal stent and 769 patients (64%) received a drug-eluting stent. A history of previous PCI, current non-ST-elevation myocardial infarction, anterior descending artery as the infarct-related artery and being initially admitted to a hospital with a catheterization laboratory were associated with drug-eluting stent implantation. Age under 45 or over 80, anemia and previous anticoagulation and/or atrial fibrillation were associated with bare-metal stent use. Approximately two-thirds of patients received drug-eluting stents, which were less frequently implanted in patients with ST-elevation myocardial infarction, aged over 80 years, female, with a previous history of stroke, anticoagulation and/or atrial fibrillation and anemia. Patients who had previously undergone PCI and those with the anterior descending artery as the infarct-related artery were more likely to receive a drug-eluting stent. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. Echocardiographic assessment of the aortic root dilatation in adult patients after tetralogy of Fallot repair.

    PubMed

    Cruz, Cristina; Pinho, Teresa; Lebreiro, Ana; Silva Cardoso, José; Maciel, Maria Júlia

    2013-06-01

    Transthoracic echocardiography is an important tool after tetralogy of Fallot repair, of which aortic root dilatation is a recognized complication. In this study we aimed to assess its prevalence and potential predictors. We consecutively assessed adult patients by transthoracic echocardiography after tetralogy of Fallot repair, and divided them into two groups based on the maximum internal aortic diameter at the sinuses of Valsalva in parasternal long-axis view: group 1 with aortic root dilatation (≥38 mm) and group 2 without dilatation (<38 mm). A total of 53 patients were included, mean age 32±10 years, with a mean time since surgery of 23±7 years. An aortopulmonary shunt had been performed prior to complete repair in 25 patients, and a transannular patch was used in 19 patients. Aortic root measurement was possible in all patients. Aortic root dilatation was identified in eight patients (15%), all male. Male gender (p=0.001), body surface area (1.93±0.10 vs. 1.70±0.20 m(2), p=0.03) and increased left ventricular end-diastolic diameter (p=0.005) were predictors of aortic root dilatation. None of the surgical variables studied were predictors of aortic root dilatation. The prevalence of aortic root dilatation in this cohort was low and male gender was a predictor of its occurrence. The type of repair and time to surgery did not influence its occurrence. Quantification of aortic root diameter is possible by transthoracic echocardiography; we suggest indexing it to body surface area in clinical practice. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. What is the effect on cardiovascular events of reducing hyperuricemia with allopurinol? An evidence-based review.

    PubMed

    Guedes, Marta; Esperança, Ana; Pereira, Ana Cristina; Rego, Catarina

    2014-11-01

    High levels of uric acid (UA) have been associated with cardiovascular (CV) disease, but its role as an independent risk factor is the subject of debate. Treating hyperuricemia may be useful in reducing CV risk. To review the evidence on the effect of treatment with allopurinol in patients with hyperuricemia on reducing CV events. We searched medical databases for randomized controlled trials (RCT), cohort studies (CS) and case-control studies (CCS), meta-analyses, systematic reviews and guidelines, published between January 2002 and December 2013 in Portuguese and English. Level of evidence (LE) and strength of recommendation were graded according to the definitions used by the European Society of Cardiology. Out of 46 articles, one RCT, three CS and one CCS were included. In the RCT, treatment with allopurinol decreased CV events in patients with moderate chronic renal failure by 71% compared to controls (LE B). In one CS, patients treated with high doses had a greater reduction in CV events compared to low doses (LE B). The other two CS, in patients with heart failure (HF), found similar benefits in patients treated with high doses of allopurinol (LE B). In the CCS, in patients with HF and a history of gout, treatment with allopurinol reduced HF admission and all-cause mortality (LE B). Prolonged treatment with high doses of allopurinol may be associated with a reduction in morbidity and mortality in high CV risk populations (class of recommendation IIa). More studies evaluating the effect of therapy with allopurinol in reducing CV events in patients with and without risk are needed. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Multimarker approach with cystatin C, N-terminal pro-brain natriuretic peptide, C-reactive protein and red blood cell distribution width in risk stratification of patients with acute coronary syndromes.

    PubMed

    Vieira, Catarina; Nabais, Sérgio; Ramos, Vítor; Braga, Carlos; Gaspar, António; Azevedo, Pedro; Álvares Pereira, Miguel; Salomé, Nuno; Correia, Adelino

    2014-03-01

    Biomarkers have emerged as interesting predictors of risk in patients with acute coronary syndromes (ACS). The aim of this study was to determine the utility of the combined measurement of cystatin C (CysC), C-reactive protein (CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP) and red blood cell distribution width (RDW) in the risk stratification of patients with ACS. In this prospective study including 682 patients consecutively admitted to a coronary care unit for ACS, baseline measurements of CysC, CRP, NT-proBNP and RDW were performed. Patients were categorized on the basis of the number of elevated biomarkers at presentation. The primary outcome was 6-month mortality. The number of biomarkers elevated on admission (study score) was an independent predictor of 6-month mortality; patients with four biomarkers elevated on admission had a significantly higher risk of 6-month mortality compared with patients with none or one. In addition, in patients with high risk defined by the GRACE score, our multimarker score was able to further categorize their risk of 6-month mortality. A multimarker approach using CysC, NT-proBNP, CRP and RDW was an independent predictor of 6-month mortality and added prognostic information to the GRACE risk score in patients with ACS and high risk defined by GRACE, with increasing mortality in patients with a higher number of elevated biomarkers on admission. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Non-ST-elevation acute coronary syndromes in octogenarians: applicability of the GRACE and CRUSADE scores.

    PubMed

    Faustino, Ana; Mota, Paula; Silva, Joana

    2014-10-01

    Assessment of ischemic and bleeding risk is critical for the management of elderly patients with acute coronary syndromes, but it has been little studied. This study aims to assess the applicability of the GRACE and CRUSADE scores in patients aged ≥80 years with non-ST-elevation acute coronary syndrome (NSTE-ACS), and to identify the main predictors of in-hospital mortality and major bleeding in this population. We analyzed 544 patients aged ≥80 years with NSTE-ACS included in the Portuguese Registry on Acute Coronary Syndromes and identified the predictors of in-hospital mortality and major bleeding during hospitalization. Prediction models were created for these endpoints, then compared with the GRACE and CRUSADE scores, and their applicability to the study population was assessed. Use of coronary angiography was associated with reduced risk of in-hospital mortality, without increasing risk of major bleeding (OR 0.2, 95% CI 0.006-0.49, p=0.001). Major bleeding was an independent predictor of in-hospital mortality (OR 10.9, 95% CI 2.36-50.74, p=0.002), and was associated with comorbidities and pharmacological therapy during hospitalization. The GRACE score showed good diagnostic accuracy for in-hospital mortality (AUC 0.75, 95% CI 0.63-0.87, p<0.001), but the CRUSADE score had weak discriminatory capacity for major bleeding (AUC 0.51, 95% CI 0.30-0.63, p=0.942), unlike our prediction model (AUC 0.68, 95% CI 0.52-0.84, p=0032). The GRACE score is suitable for risk assessment in octogenarians with NSTE-ACS, but the CRUSADE score is inadequate, and new scores are required to assess bleeding risk in this age-group. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?

    PubMed

    Garay, Alberto; Ariza-Solé, Albert; Formiga, Francesc; Lorente, Victoria; Sánchez-Salado, José C; Salazar-Mendiguchía, Joel; Roura, Gerard; Muntané, Guillem; Alegre, Oriol; Fuentes, Lara; Gómez-Hospital, Joan A; Cequier, Angel

    2016-12-01

    Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia. All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC). We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044). Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. ProACS risk score: An early and simple score for risk stratification of patients with acute coronary syndromes.

    PubMed

    Timóteo, Ana Teresa; Aguiar Rosa, Sílvia; Afonso Nogueira, Marta; Belo, Adriana; Cruz Ferreira, Rui

    2017-02-01

    There are barriers to proper implementation of risk stratification scores in patients with acute coronary syndromes (ACS), including their complexity. Our objective was to develop a simple score for risk stratification of all-cause in-hospital mortality in a population of patients with ACS. The score was developed from a nationwide ACS registry. The development and internal validation cohorts were obtained from the first 31829 patients, randomly separated (60% and 40%, respectively). The external validation cohort consisted of the last 8586 patients included in the registry. This cohort is significantly different from the other cohorts in terms of baseline characteristics, treatment and mortality. Multivariate logistic regression analysis was used to select four variables with the highest predictive potential. A score was allocated to each parameter based on the regression coefficient of each variable in the logistic regression model: 1 point for systolic blood pressure ≤116 mmHg, Killip class 2 or 3, and ST-segment elevation; 2 points for age ≥72 years; and 3 points for Killip class 4. The new score had good discriminative ability in the development cohort (area under the curve [AUC] 0.796), and it was similar in the internal validation cohort (AUC 0.785, p=0.333). In the external validation cohort, there was also excellent discriminative ability (AUC 0.815), with an adequate fit. The ProACS risk score enables easy and simple risk stratification of patients with ACS for in-hospital mortality that can be used at the first medical contact, with excellent predictive ability in a contemporary population. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Validation of two US risk scores for percutaneous coronary intervention in a single-center Portuguese population of patients with acute coronary syndrome.

    PubMed

    Timóteo, Ana T; Monteiro, André V; Portugal, Guilherme; Teixeira, Pedro; Aidos, Helena; Ferreira, Maria L; C Ferreira, Rui

    2016-02-01

    New scores have been developed and validated in the US for in-hospital mortality risk stratification in patients undergoing coronary angioplasty: the National Cardiovascular Data Registry (NCDR) risk score and the Mayo Clinic Risk Score (MCRS). We sought to validate these scores in a European population with acute coronary syndrome (ACS) and to compare their predictive accuracy with that of the GRACE risk score. In a single-center ACS registry of patients undergoing coronary angioplasty, we used the area under the receiver operating characteristic curve (AUC), a graphical representation of observed vs. expected mortality, and net reclassification improvement (NRI)/integrated discrimination improvement (IDI) analysis to compare the scores. A total of 2148 consecutive patients were included, mean age 63 years (SD 13), 74% male and 71% with ST-segment elevation ACS. In-hospital mortality was 4.5%. The GRACE score showed the best AUC (0.94, 95% CI 0.91-0.96) compared with NCDR (0.87, 95% CI 0.83-0.91, p=0.0003) and MCRS (0.85, 95% CI 0.81-0.90, p=0.0003). In model calibration analysis, GRACE showed the best predictive power. With GRACE, patients were more often correctly classified than with MCRS (NRI 78.7, 95% CI 59.6-97.7; IDI 0.136, 95% CI 0.073-0.199) or NCDR (NRI 79.2, 95% CI 60.2-98.2; IDI 0.148, 95% CI 0.087-0.209). The NCDR and Mayo Clinic risk scores are useful for risk stratification of in-hospital mortality in a European population of patients with ACS undergoing coronary angioplasty. However, the GRACE score is still to be preferred. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  14. Multivessel approach in ST-elevation myocardial infarction: impact on in-hospital morbidity and mortality.

    PubMed

    Santos, Ana Rita; Piçarra, Bruno Cordeiro; Celeiro, Margarida; Bento, Ângela; Aguiar, José

    2014-02-01

    Multivessel disease in ST-elevation myocardial infarction (STEMI) is associated with a worse prognosis. A multivessel approach at the time of primary percutaneous coronary intervention (PCI) is the subject of debate. To assess the impact of a multivessel approach on in-hospital morbidity and mortality in patients with STEMI undergoing primary PCI. We studied patients from the Portuguese Registry of Acute Coronary Syndromes with STEMI and multivessel disease who underwent primary PCI. The 257 patients were divided into two groups: those who underwent PCI of the culprit artery only and those who underwent multivessel PCI. Cardiovascular risk factors, STEMI location, in-hospital treatment, number and type of diseased and treated arteries, type of stent implanted and ejection fraction were recorded. The primary end-point was defined as in-hospital mortality and the secondary end-point as the presence of at least one of the following complications: major bleeding, need for transfusion, invasive ventilation, heart failure and reinfarction. Multivessel disease was found in 43.3% of the study population and a multivessel approach was adopted in 19.2% of these patients. There were no differences between the groups in cardiovascular risk factors or electrocardiographic presentation of STEMI. Patients undergoing multivessel PCI were more likely to be treated with drug-eluting stents and glycoprotein IIb/IIIa inhibitors, and less likely to receive heparin therapy. There were no differences between the groups with regard to in-hospital mortality or the incidence of complications. In our population of patients with STEMI, a multivessel approach appears to be safe and not associated with increased in-hospital mortality or morbidity. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Venous insufficiency and thromboembolic disease in bariatric surgery patients.

    PubMed

    Bellen, Bonno van; Godoy, Ivan de Barros; Reis, Andrea Almeida; Bertevello, Pedro

    2013-01-01

    Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI) and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrasonographic findings), type of surgery (open or laparoscopic), abdominal circumference, body mass index (BMI) and post-operative ultrasonography search for venous insufficiency and deep venous thrombosis. Between March 2007 and December 2009, 95 patient candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%), the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%), but no one had clinically manifested pulmonary embolism. No relation between BMI, CEAP classification and venous ultrasonographic findings were found. Although prophylaxis was used in all patients, the incidence of post

  16. Cardiorespiratory optimal point during exercise testing as a predictor of all-cause mortality.

    PubMed

    Ramos, Plínio S; Araújo, Claudio Gil S

    2017-04-01

    The cardiorespiratory optimal point (COP) is a novel index, calculated as the minimum oxygen ventilatory equivalent (VE/VO2) obtained during cardiopulmonary exercise testing (CPET). In this study we demonstrate the prognostic value of COP both independently and in combination with maximum oxygen consumption (VO2max) in community-dwelling adults. Maximal cycle ergometer CPET was performed in 3331 adults (66% men) aged 40-85 years, healthy (18%) or with chronic disease (81%). COP cut-off values of <22, 22-30, and >30 were selected based on the log-rank test. Risk discrimination was assessed using COP as an independent predictor and combined with VO2max. Median follow-up was 6.4 years (7.1% mortality). Subjects with COP >30 demonstrated increased mortality compared to those with COP <22 (hazard ratio [HR] 6.86, 95% confidence interval [CI] 3.69-12.75, p<0.001). Multivariate analysis including gender, age, body mass index, and the forced expiratory volume in 1 s/vital capacity ratio showed adjusted HR for COP >30 of 3.72 (95% CI 1.98-6.98; p<0.001) and for COP 22-30 of 2.15 (95% CI 1.15-4.03, p<0.001). Combining COP and VO2max data further enhanced risk discrimination. COP >30, either independently or in combination with low VO2max, is a good predictor of all-cause mortality in community-dwelling adults (healthy or with chronic disease). COP is a submaximal prognostic index that is simple to obtain and adds to CPET assessment, especially for adults unable or unwilling to achieve maximal exercise. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. [Management of adult secondary insomnia in primary health care].

    PubMed

    Cavadas, Luís Filipe; Ribeiro, Lúcia

    2011-01-01

    Insomnia is the most common sleep disorder in adults, with secondary insomnia being the most prevalent. This sleep disorder is associated with important medical and social consequences. The General Practitioner (GP) plays a key role in the diagnosis of insomnia, which may affect about 69% of their patients in the PHC (Primary Health Care). Recognize the differential diagnosis of secondary insomnia in adults, evaluate and manage these patients in the PHC, appropriately use the treatments available and meet the criteria for referral. Bibliographic search in MEDLINE databases, and evidence based review databases, using the MeSH terms: Primary Health Care, Sleep Disorders, Insomnia, for articles published since January 2000 until July 2009, in English, Portuguese, French and Spanish. Index de Revistas Médicas Portuguesas and scientific societies dedicated to sleep disorders were searched. Mood and anxiety disorders are the main co-morbidities associated with secondary insomnia, being present in 30% to 50% of patients with insomnia. The medical pathology and substance abuse are present respectively in 10% of patients. It is essential a proper clinical history, with a history of sleep, sleep diary and the partner information. There is evidence that the combination of specific pharmacological treatments (benzodiazepines and the benzodiazepine receptor agonists) with the nonpharmacological (cognitive-behavioral therapy) may be useful in secondary insomnia, as co-adjuvant treatment of the underlying disease. There are several treatment options with their indications and adverse effects. The criteria for referral should be defined according to the availability of human resources. Due to the high prevalence and the serious consequences of secondary insomnia in adults, it must be systematically managed by the GP. It is important to know and to use non-pharmacological therapy in GP consultation, because this therapy was shown to be important in treating this type of insomnia

  18. [Dangerous liaisons--physicians and pharmaceutical sales representatives].

    PubMed

    Granja, Mónica

    2005-01-01

    Interactions between physicians and detailers (even when legitimate ones) raise scientific and ethical questions. In Portugal little thinking and discussion has been done on the subject and the blames for bribery have monopolized the media. This work intended to review what has been said in medical literature about these interactions. How do physicians see themselves when interacting with pharmaceutical companies and their representatives? Do these companies in fact change their prescriptive behaviour, and, if so, how do they change it? How can physicians interact with detailers and still keep their best practice? A Medline research, from 1966 till 2002, was performed using the key-words as follows. A database similar to Medline but concerning medical journals published in Portugal, Index das Revistas Médicas Portuguesas, was also researched from 1992 to 2002. Pharmaceutical companies are profit bound and they allot promoting activities, and detailing in particular, huge amounts of money. Most physicians hold firmly to the belief that they are able to resist and not be influenced by drug companies promotion activities. Nevertheless, all previous works on literature tell us the opposite. Market research also indicates that detailers effectively promote drug sales. Various works also suggest that the information detailers provide to physicians may be largely incorrect, even comparing it to the written information provided by the pharmaceutical companies they work for. The frequency at which portuguese physicians (especially family physicians) contact with pharmaceutical sales representatives is higher than the frequency reported in countries where the available studies come from (namely, Canada and the United States of America). This may put portuguese physicians at a higher risk, making it imperative that work and wide debate are initiated among the class.

  19. Relation between heart rate recovery after exercise testing and body mass index.

    PubMed

    Barbosa Lins, Tereza Cristina; Valente, Lucila Maria; Sobral Filho, Dário Celestino; Barbosa e Silva, Odwaldo

    2015-01-01

    Impaired heart rate (HR) recovery after exercise testing is considered a predictor of cardiovascular mortality as it reflects vagus nerve dysfunction. To assess the relationship between body mass index (BMI) and HR recovery after exercise. We analyzed the records of 2443 patients of both sexes, aged between 20 and 59 years, in sinus rhythm, not using negative chronotropic agents and with no myocardial ischemic response to exercise testing carried out at a specialist clinic, between 2005 and 2011. BMI was categorized as normal (18.5-<25 kg/m(2)), overweight (25-≤30 kg/m(2)) or obese (>30 kg/m(2)). The different BMI groups were compared in terms of HR recovery after exercise, which was calculated as the difference between maximum HR during exercise and in the first minute of recovery. Recovery was considered impaired when the difference was ≤12 bpm. Eighty-seven (3.6%) patients presented impaired recovery, which was three times more prevalent in the obese group and twice as prevalent in the overweight group compared with the normal group (p<0.001 and p=0.010, respectively). Obese patients presented higher basal HR and lower maximum HR, as well as reduced chronotropic reserve (p<0.001). In multivariate analysis, impaired HR recovery was associated with overweight (relative risk [RR]=1.8; p=0.035), obesity (RR=2; p=0.016), number of metabolic equivalents (RR=0.82; p<0.001) and resting HR (RR=1.05; p<0.001). The hazard ratio for hypertension was 2 (p=0.083, NS). Impaired HR recovery was associated with higher BMI, demonstrating that obese individuals present vagus nerve dysfunction. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. Immune function of peripheral T cells in patients with venous thromboembolism or coronary artery atherosclerosis.

    PubMed

    Zhou, Lin; Song, Haoming; Xu, Wenjun; Xu, Jiahong; Jiang, Jinfa; Gong, Zhu; Liu, Yang; Yan, Wenwen; Wang, Lemin

    2014-06-01

    Recent studies have shown that the major risk factors for arterial thrombotic diseases are closely associated with venous thromboembolism (VTE). This study aimed to investigate the expression of CD3, CD4 and CD8 in T lymphocytes, the CD4/CD8 ratio and high-sensitivity C-reactive protein (hs-CRP) levels in patients with VTE, coronary artery atherosclerosis (CAA) and healthy subjects. A total of 82 healthy subjects, 51 VTE patients and 114 CAA patients were recruited, and the expression of CD3, CD4 and CD8 in T lymphocytes and the CD4/CD8 ratio were determined. Serum hs-CRP was also measured. Compared to healthy subjects, VTE patients had significantly reduced CD3 expression (p=0.019), comparable CD4 expression (p=0.868), significantly reduced CD8 expression (p<0.001) and increased CD4/CD8 ratio (p=0.044). However, VTE patients had comparable expression of CD3, CD4 and CD8 and CD4/CD8 ratio to CAA patients. In addition, among patients with VTE or CAA, the proportion of patients with reduced CD3+ and CD8+ T lymphocytes or increased CD4/CD8 ratio was significantly higher than in healthy subjects. In addition, hs-CRP in both VTE and CAA groups was significantly higher than in healthy subjects. The antigen recognition and signal transduction activation of T cells is significantly reduced in patients with VTE or CAA, and the killing effect of T cells on pathogens, including viruses, is also significantly compromised. In addition, inflammatory and immune mechanisms are involved in the occurrence and development of venous and arterial thrombosis. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Usefulness of right ventricular and right atrial two-dimensional speckle tracking strain to predict late arrhythmic events in adult patients with repaired Tetralogy of Fallot.

    PubMed

    Timóteo, Ana T; Branco, Luísa M; Rosa, Sílvia A; Ramos, Ruben; Agapito, Ana F; Sousa, Lídia; Galrinho, Ana; Oliveira, José A; Oliveira, Mário M; Ferreira, Rui C

    2017-01-01

    To determine whether right ventricular and/or atrial speckle tracking strain is associated with previous arrhythmic events in patients with repaired tetralogy of Fallot. We studied right ventricular and atrial strain in 100 consecutive patients with repaired tetralogy of Fallot referred for routine echocardiographic evaluation. Patients were divided into two groups, one with previous documentation of arrhythmias (n=26) and one without arrhythmias, in a median follow-up of 22 years. Patients with arrhythmias were older (p<0.001) and had surgical repair at an older age (p=0.001). They also had significantly reduced right ventricular strain (-14.7±5.5 vs. -16.9±4.0%, p=0.029) and right atrial strain (19.1±7.7% vs. 25.8±11.4%, p=0.001). Neither right ventricular nor right atrial strain were independent predictors of the presence of a history of documented arrhythmias, which was associated with age at correction and with the presence of residual defects. In a subanalysis after excluding 23 patients who had had more than one corrective surgery, right ventricular strain was an independent predictor of the presence of previous arrhythmic events (OR 1.19, 95% CI 1.02-1.38, p=0.025). Right atrial strain was also an independent predictor after adjustment (OR 0.93, 95% CI 0.87-0.99, p=0.029). The ideal cut-off for right ventricular strain was -15.3% and for right atrial strain 23.0%. Compared with conventional echocardiographic parameters, strain measures of the right heart are associated with the presence of arrhythmic events, and may be useful for risk stratification of patients with repaired tetralogy of Fallot, although a prospective study is required. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Serum visfatin and omentin levels in slow coronary flow.

    PubMed

    Ucgun, Taner; Başar, Cengiz; Memişoğulları, Ramazan; Demirin, Hilmi; Türker, Yasin; Aslantaş, Yusuf

    2014-12-01

    The adipocytokines visfatin and omentin have a direct effect on inflammation and endothelial injury. The expression of visfatin is closely associated with the expression of proinflammatory cytokines. Omentin has an anti-inflammatory effect and is inversely associated with coronary artery disease (CAD). The slow coronary flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. The pathophysiology of SCF has not been clearly identified, although multiple abnormalities including endothelial dysfunction, atherothrombosis and inflammation have been reported. However, the relationship between visfatin, omentin and SCF is still unknown. In this study, we aimed to investigate the relationship of these adipocytokines with SCF. The study included slow coronary flow (n=45) and normal coronary flow (n=55) subjects, according to the corrected TIMI frame count, who underwent angiography in the catheterization laboratory of Duzce University. Statistical analyses were performed with SPSS version 12. Visfatin levels were significantly higher in patients with SCF than in controls (p<0.001). Plasma omentin levels were lower in the SCF group than in controls, although without statistical significance. Visfatin, gender and platelet count were significant predictors of SCF in multivariate logistic regression analysis (OR 0.748, 95% CI 0.632-0.886, p=0.01; OR 30.016, 95% CI 4.355-206.8, p=0.01; OR1.028, 95% CI 1.006-1.050, p=0.011, respectively). Adipocytokines such as visfatin and omentin may play a role in the pathogenesis of coronary slow flow. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. Disability-adjusted life years lost due to ischemic heart disease in mainland Portugal, 2013.

    PubMed

    Henriques, Ana; Araújo, Carla; Viana, Marta; Laszczynska, Olga; Pereira, Marta; Bennett, Kathleen; Lunet, Nuno; Azevedo, Ana

    2017-04-01

    Estimates of the burden of ischemic heart disease (IHD), including geographic differences, should support health policy decisions. We set out to estimate the burden of IHD in mainland Portugal in 2013 by calculating disability-adjusted life years (DALYs) and to compare this burden between five regions. Years of life lost (YLLs) were calculated by multiplying the number of IHD deaths in 2013 (Statistics Portugal) by the life expectancy at the age at which death occurred. Years lived with disability (YLDs) were computed as the number of cases of acute coronary syndrome, stable angina and ischemic heart failure multiplied by an average disability weight. Crude and age-standardized DALYs (direct method, Standard European Population) were calculated for mainland Portugal and for the Northern, Central, Lisbon, Alentejo and Algarve regions. In 2013, 95413 DALYs were lost in mainland Portugal due to IHD. YLLs accounted for 88.3% of the disease burden. Age-standardized DALY rates per 1000 population were higher in men than in women, across the entire country (8.9 in men; 3.4 in women) and within each region, ranging from 7.3 in the Northern and Central regions to 11.8 in the Algarve in men, and from 2.6 in the Northern region to 4.6 in Lisbon in women. Nearly 100000 DALYs were lost to IHD in Portugal, mostly through early mortality. This study enables accurate comparisons with other countries and between regions; however, it highlights the need for population-based studies to obtain specific data on morbidity. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Tuberculosis in children from diagnosis to decision to treat.

    PubMed

    Ramos, S; Gaio, R; Ferreira, F; Leal, J Paulo; Martins, S; Santos, J Vasco; Carvalho, I; Duarte, R

    2017-07-25

    Confirmation of tuberculosis (TB) in children is difficult, so clinicians use different procedures when deciding to treat. Identify criteria to initiate and maintain TB treatment in children younger than 5 years-old, without diagnosis confirmation. A web-based survey was distributed by email to the corresponding authors of journal articles on childhood TB. The observations were clustered into disjoint groups, and analyzed by Ward's method. We sent out 260 questionnaires and received 64 (24.6%) responses. Forty-six respondents (71.9%) said that microbiological confirmation was not important for initiation of anti-TB treatment, and that the epidemiological context and signs/symptoms suggestive of disease were most important. Sixty-one respondents (95.3%) said that the decision to continue therapy was mainly dependent on clinical improvement. A cluster of older respondents (median age: 52 years-old) who were active at a hospital or primary health care centre placed the most value on immunological test results and chest X-rays. A cluster of younger respondents (median age: 38 years-old) who were less experienced in management of TB placed more value on Interferon Gamma Release Assay (IGRA) results and chest computed tomography (CT) scans. A cluster of respondents with more experience in treating TB and working at specialized TB centres placed greater value on the clinical results and specific radiological alterations ("tree-in-bud" pattern and pleural effusion). TB management varied according to the age, work location and experience of the clinicians. It is necessary to establish standardized guidelines used for the diagnosis and decision to treat TB in children. Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  5. Brief psychological intervention in phase I of cardiac rehabilitation after acute coronary syndrome.

    PubMed

    Fernandes, Ana Cláudia; McIntyre, Teresa; Coelho, Rui; Prata, Joana; Maciel, Maria Júlia

    2017-09-01

    Acute coronary syndrome (ACS) is an important cause of mortality and significant personal and financial costs. Cardiac rehabilitation (CR) programs have shown positive effects in reducing cardiovascular mortality and improving functional capacity. However, adherence is low and appears to be influenced by psychosocial factors, such as patients' cognitions and emotional state. The objective was to evaluate the efficacy of a brief in-hospital psychological intervention to promote cognitive and emotional adaptation after ACS. One hundred and twenty-one patients with ACS, admitted to a coronary care unit in a central hospital, were randomized to an experimental group (EG, n=65) and a control group (CG, n=56). Portuguese versions of the HADS and BIPQ were used to measure emotional well-being and illness cognitions. Two 1 h 15 min sessions were conducted 2-3 days after hospital admission, and a 20-minute follow-up session took place one month after discharge. Patients were assessed at four different time points: pre-test, post-test, and at 1- and 2-month follow-up. The intervention had significant effects on anxiety, depression and illness cognitions. Anxiety and depression were significantly reduced and illness cognitions improved significantly in the EG compared to the control group. For the EG, these changes were maintained or enhanced at 1- and 2-month follow-up, whereas for the CG there was a deterioration in psychosocial adjustment. These results indicate that a brief psychological intervention program delivered during hospitalization for ACS and combined with standard medical care can have positive effects in terms of psychosocial outcomes that have proven impact on cardiac rehabilitation and prognosis. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Triatoma maculata, the Vector of Trypanosoma cruzi, in Venezuela. Phenotypic and Genotypic Variability as Potential Indicator of Vector Displacement into the Domestic Habitat

    PubMed Central

    García-Alzate, Roberto; Lozano-Arias, Daisy; Reyes-Lugo, Rafael Matías; Morocoima, Antonio; Herrera, Leidi; Mendoza-León, Alexis

    2014-01-01

    Triatoma maculata is a wild vector of Trypanosoma cruzi, the causative agent of Chagas disease; its incursion in the domestic habitat is scant. In order to establish the possible domestic habitat of T. maculata, we evaluated wing variability and polymorphism of genotypic markers in subpopulations of T. maculata that live in different habitats in Venezuela. As markers, we used the mtCyt b gene, previously apply to evaluate population genetic structure in triatomine species, and the β-tubulin gene region, a marker employed to study genetic variability in Leishmania subgenera. Adults of T. maculata were captured in the period 2012–2013 at domestic, peridomestic (PD), and wild areas of towns in the Venezuelan states of Anzoátegui, Bolívar, Portuguesa, Monagas, Nueva Esparta, and Sucre. The phenotypic analysis was conducted through the determination of the isometric size and conformation of the left wing of each insect (492 individuals), using the MorphoJ program. Results reveal that insects of the domestic habitat showed significant reductions in wing size and variations in anatomical characteristics associated with flying, in relation to the PD and wild habitats. The largest variability was found in Anzoátegui and Monagas. The genotypic variability was assessed by in silico sequence comparison of the molecular markers and PCR-RFLP assays, demonstrating a marked polymorphism for the markers in insects of the domestic habitat in comparison with the other habitats. The highest polymorphism was found for the β-tubulin marker with enzymes BamHI and KpnI. Additionally, the infection rate by T. cruzi was higher in Monagas and Sucre (26.8 and 37.0%, respectively), while in domestic habitats the infestation rate was highest in Anzoátegui (22.3%). Results suggest domestic habitat colonization by T. maculata that in epidemiological terms, coupled with the presence in this habitat of nymphs of the vector, represents a high risk of transmission of Chagas disease. PMID

  7. Impact of HIV infection on cardiac deformation.

    PubMed

    Mendes, Lígia; Silva, Daniela; Miranda, Carla; Sá, Joana; Duque, Luís; Duarte, Nelson; Brito, Paula; Bernardino, Leonel; Poças, José

    2014-09-01

    The aim of this study was to detect abnormalities in left ventricular myocardial function due to HIV (human immunodeficiency virus) infection without established cardiovascular disease. An echocardiogram was performed in 50 asymptomatic HIV-infected patients (age 41 ± 6 years, 64% male) and in 20 healthy individuals. Conventional echocardiography and pulsed tissue Doppler imaging (TDI) were performed according to the guidelines. The strain rate of the basal segments was obtained with color tissue Doppler and used to evaluate systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA). Longitudinal, radial and circumferential strain were assessed by 2D speckle tracking. The mean duration of HIV infection was 10 ± 5 years, CD4 count was 579 ± 286 cells/mm³, 32% had detectable viral load, and 86% were under treatment. Of the HIV-infected patients, one had grade 1 diastolic dysfunction. The groups were not different except for E wave (HIV 0.72 ± 0.17 m/s vs. control 0.84 ± 0.16 m/s, p=0.01), longitudinal strain (-19.5 ± 1.9% vs. -21 ± 2%, p=0.005), SRS (-1.1 ± 0.28 s⁻¹ vs. -1.3 ± 0.28 s⁻¹, p=0.02) and SRE (1.8 ± 0.4 s⁻¹ vs. 2.2 ± 0.4 s⁻¹, p<0.001), but only SRS (p=0.03, 95% CI 0.036; 0.67) and SRE (p=0.001, 95% CI -0.599; -0.168) had independent value. In an HIV-infected population without established cardiovascular disease, myocardial deformation abnormalities can be detected with strain and strain rate, revealing markers of myocardial injury. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience.

    PubMed

    Faustino, Ana; Paiva, Luís; Providência, Rui; Trigo, Joana; Botelho, Ana; Costa, Marco; Leitão-Marques, António

    2013-06-01

    In non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism. To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed. Patients with non-valvular atrial fibrillation and CHADS2 score ≥2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique. After the procedure, dual antiplatelet therapy was maintained for one month, followed by single antiplatelet therapy indefinitely. Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography. The procedure was performed in 22 of the 23 selected patients (95.7%), mean age 70±9 years, CHADS2 score 3.2±0.9 and CHA2DS2-VASC score 4.7±1.4. Intraprocedural device replacement was necessary only in the first patient, due to oversizing. The following periprocedural complications were observed: one femoral pseudoaneurysm, three femoral hematomas and two minor oropharyngeal bleeds, resolved by local hemostatic measures. During a 12±8 month follow-up a mild peri-device flow and a thrombus adhering to the device, resolved under with enoxaparin therapy, were identified. The rate of transient ischemic attack (TIA)/stroke was lower than expected according to the CHADS2 score (0 vs. 6.7±2.2%). In our initial experience, this procedure proved to be a feasible, safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option. Only relatively minor complications were observed, with a lower than expected TIA/stroke rate. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Percutaneous epicardial ablation in ventricular arrhythmias.

    PubMed

    Galvão Santos, Pedro; Cavaco, Diogo; Adragão, Pedro; Scanavacca, Mauricio; Reis Santos, Katya; Belo Morgado, Francisco; Carmo, Pedro; Costa, Francisco; Bernardo, Ricardo; Nunes, Manuela; Abecasis, Miguel; Neves, José; Mendes, Miguel

    2014-05-01

    Reentrant circuits of ventricular tachycardia may involve not only the endocardium but also the epicardium. Epicardial ablation can be useful in these situations. The aim of this study was to assess efficacy, safety and complications in a series of consecutive patients who underwent ablation of ventricular tachycardia with epicardial mapping. The study included all patients undergoing ventricular tachycardia ablation with epicardial mapping from 2004 to 2012. Of a total of 95 ablations, an epicardial approach was attempted in nine patients, eight male, mean age 58±12 years. Endocardial mapping was performed in all patients previously or simultaneously. The etiology of the arrhythmia was non-ischemic in eight patients and ischemic in one. We compared the number of events in the six months prior to the epicardial procedure and six months after. Percutaneous epicardial access was achieved in eight patients. In one case it was not possible due to the presence of adhesions. In none of the patients was the procedure repeated and there were no major complications during hospitalization. In a mean follow-up of 3.5±1.2 years, one patient suffered stroke; there were no other medium-to-long-term complications and the number of ventricular tachycardia episodes was reduced in all patients after ablation. Epicardial radiofrequency ablation of ventricular tachycardia was effective in reducing morbidity in eight patients, with a low risk of complications in the short and medium-to-long term. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. [Characterization of lipid profile in primary health care users in Portugal].

    PubMed

    Cortez-Dias, Nuno; Robalo Martins, Susana; Belo, Adriana; Fiúza, Manuela

    2013-12-01

    To characterize the distribution of total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and triglycerides in primary health care users. We performed a cross-sectional study in a primary care setting, involving 719 general practitioners based on stratified distribution proportional to the population density of each region of Portugal. The first two adult patients scheduled for an appointment on a given day were invited to participate. A questionnaire was applied to assess sociodemographic, clinical and laboratory data including lipid profile. The study included 16 856 individuals (mean age 58.1±15.1 years; 61.6% women). Data on TC, LDL-C, HDL-C and triglycerides were available for 95.9% (n=16 159), 59.1% (n=9956), 95.4% (n=16 074) and 97.9% (n=16 494) of the population, respectively. Hypercholesterolemia (TC ≥200 mg/dl) was detected in 47%, and 38.4% had high levels of LDL-C (≥130 mg/dl). Hypertriglyceridemia (≥200 mg/dl) and low HDL-C (<40 mg/dl) were less prevalent, affecting roughly 13% of the population. Dyslipidemia was more common in middle-aged men and in post-menopausal women. Of the population aged over 40, 54.1% met eligibility criteria for lipid-lowering therapy and 44.7% were medicated with statins, but only 16.0% of these had TC ≤175 mg/dl. Dyslipidemia is highly prevalent in primary health care users in Portugal. It is particularly common in middle-aged men and post-menopausal women, who should be considered target groups for preventive public health measures. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. The relationship between 24-hour ambulatory blood pressure load and neutrophil-to-lymphocyte ratio.

    PubMed

    Çimen, Tolga; Sunman, Hamza; Efe, Tolga Han; Erat, Mehmet; Şahan, Haluk Furkan; Algül, Engin; Guliyev, İlkin; Akyel, Ahmet; Doğan, Mehmet; Açıkel, Sadık; Yeter, Ekrem

    2017-02-01

    The neutrophil-to-lymphocyte ratio (NLR) is established as a reliable marker of systemic inflammation. Low-grade inflammation has a key role in the pathogenesis and progression of hypertension (HTN). Blood pressure (BP) load, defined as the percentage of abnormally elevated BP readings, is a good marker of HTN severity. We aimed to evaluate the relationship between HTN severity and NLR using averaged ambulatory BP readings and BP load. A total of 300 patients with untreated essential HTN were included in this cross-sectional study. Patients were divided into quartiles according to NLR values (first: <1.55; second: 1.55-1.92; third: 1.92-2.48; and fourth: >2.48). Averaged ambulatory BP values and BP load were assessed for each quartile. In the interquartile evaluation there were no differences between quartiles in terms of baseline demographic, clinical and echocardiographic characteristics (p>0.05). Daytime systolic BP (SBP), 24-hour diastolic BP (DBP), daytime DBP, daytime SBP load, 24-hour DBP load and daytime DBP load were found to be significantly higher in the upper two quartiles (p<0.05 for all). In correlation analysis, log NLR values were found to be positively correlated with 24-hour SBP, DBP, SBP load and DBP load (Pearson coefficients of 0.194, 0.197, 0.157 and 0.181, respectively; p<0.01 for all). In multivariate analysis, log NLR had an independent association with 24-hour SBP and DBP and 24-hour SBP and DBP load. This study showed for the first time that increased NLR is independently associated with HTN severity in untreated essential HTN patients. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. [Immediate and short term effects of smoking on nasal mucociliary clearance in smokers].

    PubMed

    Proença, M; Fagundes Xavier, R; Ramos, D; Cavalheri, V; Pitta, F; Cipulo Ramos, E M

    2011-01-01

    The efficiency of mucociliary transport may vary in different conditions, such as in exposure to harmful particles of the cigarette smoke. The present study evaluated the acute and short term effects of smoking on nasal mucociliary clearance in current smokers by the quantification of the Saccharin Transit Time (STT), and to investigate its correlation with the history of tobacco consumption. Nineteen current smokers (11 men, 51 ± 16 years; BMI 23 ± 9 kg/m(2), 27 ± 11 cigarettes per day, 44 ± 25 pack-years), entering a smoking cessation intervention program, responded to a questionnaire concerning smoking history and were submitted to lung function assessment (spirometry) and the STT test. STT was assessed immediately after smoking and 8 hours after smoking. The STT test was also performed in nineteen matched healthy non-smokers' who served as control group. When compared to STT in non-smokers' (10 ± 4 min; mean ± standard deviation), smokers presented similar STT immediately after smoking (11 ± 6 min; p=0.87) and slower STT 8 hours after smoking (16 ± 6 min; p=0.005 versus non-smokers' and p=0.003 versus immediately after smoking). STT 8 hours after smoking correlated positively with age (r=0.59; p=0.007), cigarettes per day (r=0.53; p=0.02) and pack-years index (r=0.74; p=0.0003). In smokers, although the mucociliary clearance immediately after smoking is similar to non-smokers', eight hours after smoking it is reduced, and this reduction is closely related to the smoking habits. Copyright © 2010 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  13. Tempol improves lipid profile and prevents left ventricular hypertrophy in LDL receptor gene knockout (LDLr-/-) mice on a high-fat diet.

    PubMed

    Viana Gonçalves, Igor Cândido; Cerdeira, Cláudio Daniel; Poletti Camara, Eduardo; Dias Garcia, José Antônio; Ribeiro Pereira Lima Brigagão, Maísa; Bessa Veloso Silva, Roberta; Bitencourt Dos Santos, Gérsika

    2017-09-01

    Dyslipidemia is associated with increased risk of cardiovascular disease and atherosclerosis, and hence with high morbidity and mortality. This study investigated the effects of the nitroxide 4-hydroxy-2,2,6,6-tetramethylpiperidine 1-oxyl (Tempol) on lipid profile and cardiac morphology in low-density lipoprotein (LDL) receptor gene knockout (LDLr-/-) mice. Male LDLr-/- mice (three months old, approximately 22 g weight) were divided into the following groups: controls, including (1) standard chow (SC, n=8) and (2) high-fat diet (HFD, n=8); and treatment, including (3) standard chow + Tempol (SC+T, n=8) (30 mg/kg administered by gavage, once daily) and (4) high-fat diet + Tempol (HFD+T, n=8) (30 mg/kg). After 30 days of the diet/treatment, whole blood was collected for analysis of biochemical parameters (total cholesterol, triglycerides [TG], high-density lipoprotein [HDL], LDL, and very low-density lipoprotein [VLDL]). The heart was removed through thoracotomy and histological analysis of the left ventricle was performed. A significant increase in TG, LDL, and VLDL and marked left ventricular hypertrophy (LVH) were demonstrated in the HFD group relative to the SC group (p<0.05), while Tempol treatment (HFD+T group) significantly (p<0.05) prevented increases in the levels of these lipid profile markers and attenuated LVH compared with the HFD group. In this study, Tempol showed potential for the prevention of events related to serious diseases of the cardiovascular system. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Added value of cardiac magnetic resonance in etiological diagnosis of ventricular arrhythmias.

    PubMed

    Cabanelas, Nuno; Vidigal Ferreira, Maria João; Donato, Paulo; Gaspar, António; Pinto, Joana; Caseiro-Alves, Filipe; Providência, Luís Augusto

    2013-10-01

    Cardiac magnetic resonance (CMR) imaging is increasingly important in the diagnostic work-up of a wide range of heart diseases, including those with arrhythmogenic potential. To assess the added value of CMR in etiological diagnosis of ventricular arrhythmias after an inconclusive conventional investigation. Patients undergoing CMR between 2005 and 2011 for investigation of ventricular arrhythmias were included (n=113). All had documented arrhythmias. Those with a definite diagnosis from a previous investigation and those with evidence of coronary artery disease (acute coronary syndrome, typical angina symptoms, increase in biomarkers or positive stress test) were excluded. CMR results were considered relevant when they fulfilled diagnostic criteria. Of the 113 patients, 57.5% were male and mean age was 41.7 ± 16.2 years. Regarding the initial arrhythmia, 38.1% had ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and 61.9% had less complex ventricular ectopy. CMR imaging showed criteria of a specific diagnosis in 42.5% of patients, was totally normal in 36.3%, and showed non-specific alterations in the remainder. In VF/VT patients, specific criteria were found in 60.4%, and in 31.4% of those with less complex ectopy. The most frequent diagnoses were arrhythmogenic right ventricular dysplasia, ventricular non-compaction and myopericarditis. It is worth noting that, although there was no evidence of previous coronary artery disease, 6.2% of patients had a late gadolinium enhancement distribution pattern compatible with myocardial infarction. CMR gives additional and important information in the diagnostic work-up of ventricular arrhythmias after an inconclusive initial investigation. The proportion of patients with diagnostic criteria was 42.5% (60.0% in those with VF/VT), and CMR was completely normal in 36.6%. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Oxygen therapy multicentric study--a nationwide audit to oxygen therapy procedures in internal medicine wards.

    PubMed

    Neves, J T; Lobão, M J

    2012-01-01

    Oxygen therapy is a common and important treatment in Internal Medicine wards, however, several studies report that it isn't provided accordingly with the best of care. The goal of this work is to evaluate oxygen therapy procedures in Portuguese Internal Medicine wards, comparing them to the standards established by the British Thoracic Society (BTS) in its consensus statement "BTS guideline for emergency oxygen use in adult patients". Between September 3rd and 23rd 2010, each one of the 24 enrolled hospitals audited the oxygen therapy procedures for one randomly chosen day. All Internal Medicine inpatients under oxygen therapy or with oxygen prescription were included. Data was collected regarding oxygen prescription, administration and monitoring. Of the 1549 inpatients, 773 met inclusion criteria. There was an oxygen prescription in 93,4%. Most prescriptions were by a fixed dose (82,4%), but only 11,6% of those stated all the required parameters. Absence of oxygen therapy duration and monitoring were the most frequent errors. Oxygen was administered to only 77,0% of the patients with fixed dose prescriptions. FiO(2) or flow rate and the delivery device were the same as prescribed in 70,9 and 89,2% of the patients, respectively. Out of the 127 patients with oxygen therapy prescriptions by target SatO(2) range, 82,7% were on the prescribed SatO(2) objective range. Several errors were found in oxygen therapy procedures, particularly regarding fixed dose prescriptions, jeopardizing the patients. Although recommended by BTS, oxygen therapy prescriptions by target SatO(2) range are still a minority. Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  16. [Gradients, stability and conservation status of fishes in the Andean mountain streams of the Orinoco versant, Venezuela].

    PubMed

    Rodríguez-Olarte, Douglas; Barrios Gómez, Margenny

    2014-09-01

    Most Andean mountain streams of the Orinoco Basin in Venezuela, had been suffering various disturbances. In spite of this, fish communities have been poorly evaluated in terms of spatial and temporal gradients. Thus, the generation of information about these communities is a priority, since it may support conservation of regional hydrobiological resources. For this, six sites were monthly evaluated in tributaries of upper Turbio River in Sierra de Portuguesa (770-1,305 msnm), during the dry season and the beginning of the rainy season (January-April 2012); we characterized stream dimensions, substrate and water physicochemical variables. Electrofishing was used to determine the number and abundance of fish species. The fish communities and their stability were evaluated by exploring the changes in richness and abundance, coefficients of variation, hierarchical classification and non-metrical multidimensional scaling analysis. The sites conservation status was estimated with a habitat integrity index. Our results showed that richness of the 12 species found varied accord- ing to the mountain elevation, the tributaries and the conservation status of the sites. Chaetostoma dorsale, Creagrutus taphorni and Chaetostoma milesi comprised 90.8% of the relative abundance, and maintained the first ranks during the study period. The communities had little spatio-temporal variation which was associated with a gradient signed principally by the amount of shadow, rocks and gravel cover, water temperature and conductivity. Stability was moderate but varied with elevation and according to site conservation status. The tributaries in upper Turbio River were found to be under severe impacts and their fishes were found impoverished and at risk.

  17. Environment and Health in Children Day Care Centres (ENVIRH) - Study rationale and protocol.

    PubMed

    Araújo-Martins, J; Carreiro Martins, P; Viegas, J; Aelenei, D; Cano, M M; Teixeira, J P; Paixão, P; Papoila, A L; Leiria-Pinto, P; Pedro, C; Rosado-Pinto, J; Annesi-Maesano, I; Neuparth, N

    2014-01-01

    Indoor air quality (IAQ) is considered an important determinant of human health. The association between exposure to volatile organic compounds, particulate matter, house dust mite, molds and bacteria in day care centers (DCC) is not completely clear. The aim of this project was to study these effects. This study comprised two phases. Phase I included an evaluation of 45 DCCs (25 from Lisbon and 20 from Oporto, targeting 5161 children). In this phase, building characteristics, indoor CO2 and air temperature/relative humidity, were assessed. A children's respiratory health questionnaire derived from the ISAAC (International Study on Asthma and Allergies in Children) was also distributed. Phase II encompassed two evaluations and included 20 DCCs selected from phase I after a cluster analysis (11 from Lisbon and 9 from Oporto, targeting 2287 children). In this phase, data on ventilation, IAQ, thermal comfort parameters, respiratory and allergic health, airway inflammation biomarkers, respiratory virus infection patterns and parental and child stress were collected. In Phase I, building characteristics, occupant behavior and ventilation surrogates were collected from all DCCs. The response rate of the questionnaire was 61.7% (3186 children). Phase II included 1221 children. Association results between DCC characteristics, IAQ and health outcomes will be provided in order to support recommendations on IAQ and children's health. A building ventilation model will also be developed. This paper outlines methods that might be implemented by other investigators conducting studies on the association between respiratory health and indoor air quality at DCC. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  18. Obstructive sleep apnoea syndrome and HLA in the North of Portugal.

    PubMed

    Silva, Luís; Lopes, João; Ramalheira, João; Cunha, Daniela; Carvalho, Cláudia; Bettencourt, Andreia; Bras, Sandra; Costa, Sandra; Silva, M Berta; Martins-da-Silva, António

    2015-10-01

    Introduccion. El sindrome de apnea obstructiva del sueño (SAOS) es una enfermedad frecuente, compleja y poligenica, con diversas etiologias que interaccionan originando un fenotipo unico. El SAOS puede ocurrir a cualquier edad del individuo y se presume la existencia de agregacion familiar. Han sido descritos diversos factores de predisposicion, como la edad, el sexo y la obesidad. La relacion entre los polimorfismos del antigeno leucocitario humano (HLA) y trastornos del sueño esta confirmada, tanto en poblaciones europeas como no europeas. No obstante, las relaciones descritas entre los alelos HLA y SAOS no han sido coherentes y carecen de valor informativo para la clasificacion del trastorno del sueño. Objetivo. Explorar la asociacion genetica del HLA con el SAOS en una poblacion del norte de Portugal y evaluar el papel de la obesidad en el contexto del HLA en el SAOS. Pacientes y metodos. Se estudio una cohorte de 131 pacientes con SAOS. Los pacientes fueron atendidos en una clinica del sueño ambulatoria donde se valoraron los antecedentes clinicos, se les practico una polisomnografia nocturna, una prueba de latencia multiple del sueño (si lo exigio el diagnostico diferencial), analiticas y estudios demograficos. A efectos comparativos, se utilizo una poblacion de control de 223 personas sanas. Se efectuo el genotipado del HLA-DRB1 con la reaccion en cadena de la polimerasa mediante cebadores de secuencia especifica. Resultados. En esta cohorte, el alelo HLA-DRB1*03 fue identificado como un factor de predisposicion para el SAOS (24% del SAOS frente a 15% de la poblacion de control; p = 0,025; odds ratio = 1,861; intervalo de confianza al 95% = 1,081-3,205). No hubo diferencias significativas en lo referente a otros alelos HLA-DBR1*. Conclusion. El HLA-DRB1*03 es un factor de predisposicion para el SAOS en la poblacion portuguesa.

  19. Clinical analysis of the relationship between cystatin C and metabolic syndrome in the elderly.

    PubMed

    Liu, Ping; Sui, Shujian; Xu, Dongling; Xing, Xiaowei; Liu, Caixia

    2014-01-01

    Studies have shown that both cystatin C and metabolic syndrome (MetS) are associated with inflammation. We set out to investigate the correlation between serum cystatin C levels and MetS in the elderly. This prospective study was conducted in 380 elderly individuals, including 135 patients with MetS, 142 patients with metabolic disturbance (MetD), and 103 healthy elderly individuals (control group). Waist-hip ratio, waist circumference, waist-height ratio, body mass index (BMI), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure and cystatin C were measured and their mutual relations were analyzed. The higher the MetS scores, the higher the serum cystatin C concentration in these patients. Serum cystatin C concentration was closely related to waist-hip ratio, waist circumference, waist-height ratio, BMI, TG, FPG, and blood pressure, not related to LDL-C levels, and negatively correlated with HDL-C levels. Logistic regression analysis indicated that cystatin C, waist-height ratio, waist circumference, FPG, TG, SBP and pulse pressure were significantly associated with MetS (OR between cystatin C and MetS 2.164, 95% CI 1.136-8.259). Cystatin C was significantly associated with MetS in the elderly. As MetS scores rose, serum cystatin C levels increased. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. The arterial baroreflex effectiveness index in risk stratification of chronic heart failure patients who are candidates for cardiac resynchronization therapy.

    PubMed

    Fernandes Serôdio, João; Martins Oliveira, Mário; Matoso Laranjo, Sérgio; Tavares, Cristiano; Silva Cunha, Pedro; Abreu, Ana; Branco, Luísa; Alves, Sandra; Rocha, Isabel; Cruz Ferreira, Rui

    2016-06-01

    Baroreflex function is an independent marker of prognosis in heart failure (HF). However, little is known about its relation to response to cardiac resynchronization therapy (CRT). The aim of this study is to assess arterial baroreflex function in HF patients who are candidates for CRT. The study population consisted of 25 patients with indication for CRT, aged 65±10 years, NYHA functional class ≥III in 52%, QRS width 159±15 ms, left ventricular ejection fraction (LVEF) 29±5%, left ventricular end-systolic volume (LVESV) 150±48 ml, B-type natriuretic peptide (BNP) 357±270 pg/ml, and peak oxygen consumption (peak VO2) 18.4±5.0 ml/kg/min. An orthostatic tilt test was performed to assess the baroreflex effectiveness index (BEI) by the sequence method. This group was compared with 15 age-matched healthy individuals. HF patients showed a significantly depressed BEI during tilt (31±12% vs. 49±18%, p=0.001). A lower BEI was associated with higher BNP (p=0.038), lower peak VO2 (p=0.048), and higher LVESV (p=0.031). By applying a cut-off value of 25% for BEI, two clusters of patients were identified: lower risk cluster (BEI >25%) QRS 153 ms, LVESV 129 ml, BNP 146 pg/ml, peak VO2 19.0 ml/kg/min; and higher risk cluster (IEB ≤25%) QRS 167 ms, LVESV 189 ml, BNP 590 pg/ml, peak VO2 16.2 ml/kg/min. Candidates for CRT show depressed arterial baroreflex function. Lower BEI was observed in high-risk HF patients. Baroreflex function correlated closely with other clinical HF parameters. Therefore, BEI may improve risk stratification in HF patients undergoing CRT. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Inotropes and cardiorenal syndrome in acute heart failure - A retrospective comparative analysis.

    PubMed

    Madeira, Marta; Caetano, Francisca; Almeida, Inês; Fernandes, Andreia; Reis, Liliana; Costa, Marco; Gonçalves, Lino

    2017-09-01

    Cardiorenal syndrome (CRS) is common in acute heart failure (AHF), and is associated with dire prognosis. Levosimendan, a positive inotrope that also has diuretic effects, may improve patients' renal profile. Published results are conflicting. We aimed to assess the incidence of CRS in AHF patients according to the inotrope used and to determine its predictors in order to identify patients who could benefit from the most renoprotective inotrope. In a retrospective study, 108 consecutive patients with AHF who required inotropes were divided into two groups according to the inotrope used (levosimendan vs. dobutamine). The primary endpoint was CRS incidence. Follow-up for mortality and readmission for AHF was conducted. Seventy-one percent of the study population were treated with levosimendan and the remainder with dobutamine. No differences were found in heart failure etiology or chronic kidney disease. At admission, the dobutamine group had lower blood pressure; there were no differences in estimated glomerular filtration rate or cystatin C levels. The levosimendan group had lower left ventricular ejection fraction. CRS incidence was higher in the dobutamine group, and they more often had incomplete recovery of renal function at discharge. In multivariate analysis, cystatin C levels predicted CRS. The dobutamine group had higher in-hospital mortality, of which CRS and the inotrope used were predictors. Levosimendan appears to have some renoprotective effect, as it was associated with a lower incidence of CRS and better recovery of renal function at discharge. Identification of patients at increased risk of renal dysfunction by assessing cystatin C may enable more tailored therapy, minimizing the incidence of CRS and its negative impact on outcome in AHF. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. A link to better care: The effect of remote monitoring on long-term adverse cardiac events in a propensity score-matched cohort.

    PubMed

    Portugal, Guilherme; Cunha, Pedro; Valente, Bruno; Feliciano, Joana; Lousinha, Ana; Alves, Sandra; Braz, Manuel; Pimenta, Ricardo; Delgado, Ana Sofia; Oliveira, Mário; Ferreira, Rui C

    2017-03-01

    There are conflicting data regarding the clinical benefits of device-based remote monitoring (RM). We sought to assess the effect of device-based RM on long-term clinical outcomes in recipients of implantable cardioverter-defibrillators (ICDs). We assessed the incidence of adverse cardiac events, overall mortality and device therapy efficacy and safety in a propensity score-matched cohort of patients under RM compared to patients under conventional follow-up. Data on hospitalizations, mortality and cause of death were systematically assessed using a nationwide healthcare platform. The primary outcome was time to a composite outcome of first hospital admission for heart failure or cardiovascular death. Of a total of 923 implantable device recipients, 164 matched patients were identified (84 under RM, 84 under conventional follow-up). The mean follow-up was 44 months (range 1-123). There were no significant differences regarding baseline characteristics in the matched cohorts. Patients under RM had a significantly lower incidence of the primary outcome (hazard ratio [HR] 0.42, confidence interval [CI] 0.20-0.88, p=0.022); there was a non-significant trend towards lower overall mortality (HR 0.53, CI 0.27-1.04, p=0.066). No significant differences between cohorts were found regarding appropriate therapies (RM vs. conventional follow-up, 8.1 vs. 8.2%, p=NS) or inappropriate therapies (6.8 vs. 5.0%, p=NS). In a propensity score-matched cohort of ICD recipients with long-term follow-up, RM was associated with a lower rate of a combined endpoint of hospital admission for heart failure or cardiovascular death. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. A closer look at acute heart failure: Putting Portuguese and European data into perspective.

    PubMed

    Fonseca, Cândida; Araújo, Inês; Marques, Filipa; Brás, Daniel; Bettencourt, Paulo

    2016-05-01

    Acute heart failure (AHF) is a heterogeneous clinical syndrome requiring urgent therapy. The prognosis is poor after the index hospitalization, with a high risk for rehospitalization and early death. The costs of managing AHF are thus increasing rapidly. A literature review was performed to gather and compare data on prevalence and treatment and to identify gaps in AHF management, based on European and Portuguese studies. A literature search from 1995 to 2014 was conducted in selected databases (BIOSIS Previews, EMBASE and Ovid MEDLINE). Seven Portuguese and nine European studies were analyzed. The mean age of AHF patients was ≥65 years and 30-50% were women. Coronary artery disease (42.3% vs. 61.9%) and hypertension (53.3% vs. 76.7%) were identified as primary etiologies in Europe and in Portugal. Similar proportions of heart failure with preserved ejection fraction were found in the Portuguese (19.9-44.7%) and European (32.8-39.1%) studies. Overall, all-cause mortality rates were comparable (six months: 9.3-25.5% vs. 13.5-27.4%; one year: 15.9-31% vs. 17.4-46.5%), as was in-hospital mortality (5.5-14% vs. 3.8-12%) in Portuguese and European studies, respectively. Length of stay was comparable. The studies were performed in very different hospital settings and data on treatment were scarce. Gaps were identified in treatment and clinical pathways of patients with AHF. Based on the results of this review, collection and investigation of data on the disease and treatment solutions, training in disease management, and improved organization of healthcare should be the subject of further investment. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. Triple-site pacing for cardiac resynchronization in permanent atrial fibrillation - Acute phase results from a prospective observational study.

    PubMed

    Marques, Pedro; Nobre Menezes, Miguel; Lima da Silva, Gustavo; Bernardes, Ana; Magalhães, Andreia; Cortez-Dias, Nuno; Carpinteiro, Luís; de Sousa, João; Pinto, Fausto J

    2016-06-01

    Multi-site pacing is emerging as a new method for improving response to cardiac resynchronization therapy (CRT), but has been little studied, especially in patients with atrial fibrillation. We aimed to assess the effects of triple-site (Tri-V) vs. biventricular (Bi-V) pacing on hemodynamics and QRS duration. This was a prospective observational study of patients with permanent atrial fibrillation and ejection fraction <40% undergoing CRT implantation (n=40). One right ventricular (RV) lead was implanted in the apex and another in the right ventricular outflow tract (RVOT) septal wall. A left ventricular (LV) lead was implanted in a conventional venous epicardial position. Cardiac output (using the FloTrac™ Vigileo™ system), mean QRS and ejection fraction were calculated. Mean cardiac output was 4.81±0.97 l/min with Tri-V, 4.68±0.94 l/min with RVOT septal and LV pacing, and 4.68±0.94 l/min with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV). Mean pre-implantation QRS was 170±25 ms, 123±18 ms with Tri-V, 141±25 ms with RVOT septal pacing and LV pacing and 145±19 with RV apical and LV pacing (p<0.001 for Tri-V vs. both BiV and pre-implantation). Mean ejection fraction was significantly higher with Tri-V (30±11%) vs. Bi-V pacing (28±12% with RVOT septal and LV pacing and 28±11 with RV apical and LV pacing) and pre-implantation (25±8%). Tri-V pacing produced higher cardiac output and shorter QRS duration than Bi-V pacing. This may have a significant impact on the future of CRT. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  5. Predictors of response to cardiac resynchronization therapy: A prospective cohort study.

    PubMed

    Abreu, Ana; Oliveira, Mário; Silva Cunha, Pedro; Santa Clara, Helena; Santos, Vanessa; Portugal, Guilherme; Rio, Pedro; Soares, Rui; Moura Branco, Luísa; Alves, Marta; Papoila, Ana Luísa; Ferreira, Rui; Mota Carmo, Miguel

    2017-06-01

    Cardiac resynchronization therapy (CRT) has modified the prognosis of chronic heart failure (HF) with left ventricular systolic dysfunction. However, 30% of patients do not have a favorable response. The big question is how to determine predictors of response. To identify baseline characteristics that might influence echocardiographic response to CRT. We performed a prospective single-center hospital-based cohort study of consecutive HF patients selected to CRT (NYHA class II-IV, left ventricular ejection fraction (LVEF) <35% and QRS complex ≥120 ms). Responders were defined as those with a ≥5% absolute increase in LVEF at six months. Clinical, electrocardiographic, laboratory, echocardiographic, autonomic, endothelial and cardiopulmonary function parameters were assessed before CRT device implantation. Logistic regression models were used. Seventy-nine patients were included, 54 male (68.4%), age 68.1 years (standard deviation 10.2), 19 with ischemic etiology (24%). At six months, 51 patients (64.6%) were considered responders. Although by univariate analysis baseline tricuspid annular plane systolic excursion (TAPSE) and serum creatinine were significantly different in responders, on multivariate analysis only TAPSE was independently associated with response, with higher values predicting a positive response to CRT (OR=1.13; 95% CI: 1.02-1.26; p=0.020). TAPSE ≥15 mm was strongly associated with response, and TAPSE <15 mm with non-response (p=0.005). Responders had no TAPSE values below 10 mm. From a range of clinical and technical baseline characteristics, multivariate analysis only identified TAPSE as an independent predictor of CRT response, with TAPSE <15 mm associated with non-response. This study highlights the importance of right ventricular dysfunction in CRT response. ClinicalTrials.gov identifier: NCT02413151. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Sacubitril/valsartan: An important piece in the therapeutic puzzle of heart failure.

    PubMed

    Marques da Silva, Pedro; Aguiar, Carlos

    2017-09-01

    Sacubitril/valsartan (LCZ696), a supramolecular sodium salt complex of the neprilysin inhibitor prodrug sacubitril and the angiotensin receptor blocker (ARB) valsartan, was recently approved in the EU and the USA for the treatment of chronic heart failure (HF) with reduced ejection fraction (HFrEF) (NYHA class II-IV). Inhibition of chronically activated neurohormonal pathways (the renin-angiotensin-aldosterone system [RAAS] and sympathetic nervous system [SNS]) is central to the treatment of chronic HFrEF. Furthermore, enhancement of the natriuretic peptide (NP) system, with favorable cardiovascular (CV) and renal effects in HF, is a desirable therapeutic goal to complement RAAS and SNS blockade. Sacubitril/valsartan represents a novel pharmacological approach that acts by enhancing the NP system via inhibition of neprilysin (an enzyme that degrades NPs) and by suppressing the RAAS via AT1 receptor blockade, thereby producing more effective neurohormonal modulation than can be achieved with RAAS inhibition alone. In the large, randomized, double-blind PARADIGM-HF trial, replacement of an angiotensin-converting enzyme inhibitor (ACEI) (enalapril) with sacubitril/valsartan resulted in a significant improvement in morbidity and mortality in patients with HFrEF. Sacubitril/valsartan was superior to enalapril in reducing the risk of CV death or HF hospitalization (composite primary endpoint) and all-cause death, and in limiting progression of HF. Sacubitril/valsartan was generally well tolerated, with a comparable safety profile to enalapril; symptomatic hypotension was more common with sacubitril/valsartan, whereas renal dysfunction, hyperkalemia and cough were less common compared with enalapril. In summary, sacubitril/valsartan is a superior alternative to ACEIs/ARBs in the treatment of HFrEF, a recommendation that is reflected in many HF guidelines. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Clinical characteristics and prognosis of heart failure in elderly patients.

    PubMed

    Martínez-Braña, Lucía; Mateo-Mosquera, Lara; Bermúdez-Ramos, María; Valcárcel García, María de los Ángeles; Fernández Hernández, Lorena; Hermida Ameijeiras, Álvaro; Lado Lado, Francisco Luis

    2015-01-01

    The aim of this study was to assess prevalence, clinical characteristics, and prognosis in elderly patients with heart failure with preserved ejection fraction (HFPEF) compared to patients with heart failure with reduced ejection fraction (HFREF) who were followed in an internal medicine unit. In this retrospective observational study, the sample consisted of 301 patients followed in an internal medicine referral unit between January 2007 and December 2010. All patients were checked to determine their vital status on 31 December 2012. Survival was analyzed using Kaplan-Meier curves, and compared using the log-rank test. Of the 301 patients, 165 (54.8%) were women. In the 263 cases (87.4%) who underwent echocardiographic assessment, 190 (72.2%) had HFPEF and 73 (27.8%) had HFREF. Mean age was similar in the two groups (80.1 and 79.9 years; p=0.905), with a predominance of women in the HFPEF group (60.5% women, 42.5% men; p=0.025). The main etiology was hypertensive heart disease in the HFPEF group. Regarding treatment, more beta-blockers were administered in the HFREF group. No statistically significant differences were observed between the groups in terms of cardiovascular risk factors, comorbidities, NYHA functional class, or mortality. Clinical characteristics were similar for both HFPEF and HFREF patients. Women were predominant in the HFPEF group, as was hypertensive etiology. No significant differences in mortality were observed between the groups. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. [Acute kidney injury after pediatric cardiac surgery: risk factors and outcomes. Proposal for a predictive model].

    PubMed

    Cardoso, Bárbara; Laranjo, Sérgio; Gomes, Inês; Freitas, Isabel; Trigo, Conceição; Fragata, Isabel; Fragata, José; Pinto, Fátima

    2016-02-01

    To characterize the epidemiology and risk factors for acute kidney injury (AKI) after pediatric cardiac surgery in our center, to determine its association with poor short-term outcomes, and to develop a logistic regression model that will predict the risk of AKI for the study population. This single-center, retrospective study included consecutive pediatric patients with congenital heart disease who underwent cardiac surgery between January 2010 and December 2012. Exclusion criteria were a history of renal disease, dialysis or renal transplantation. Of the 325 patients included, median age three years (1 day-18 years), AKI occurred in 40 (12.3%) on the first postoperative day. Overall mortality was 13 (4%), nine of whom were in the AKI group. AKI was significantly associated with length of intensive care unit stay, length of mechanical ventilation and in-hospital death (p<0.01). Patients' age and postoperative serum creatinine, blood urea nitrogen and lactate levels were included in the logistic regression model as predictor variables. The model accurately predicted AKI in this population, with a maximum combined sensitivity of 82.1% and specificity of 75.4%. AKI is common and is associated with poor short-term outcomes in this setting. Younger age and higher postoperative serum creatinine, blood urea nitrogen and lactate levels were powerful predictors of renal injury in this population. The proposed model could be a useful tool for risk stratification of these patients. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. Continuous infusion or bolus injection of loop diuretics for patients admitted for severe acute heart failure: is one strategy better than the other?

    PubMed

    Caetano, Francisca; Mota, Paula; Almeida, Inês; Fernandes, Andreia; Botelho, Ana; Leitão Marques, António

    2015-02-01

    Intravenous loop diuretics are an essential part of acute heart failure management; however, data to guide their use is sparse. Our aim was to compare continuous intravenous infusion of loop diuretics with intravenous bolus administration in terms of efficacy and adverse events in patients admitted with severe acute heart failure. Over a period of three years, 110 patients were admitted to our cardiac intensive care unit with acute heart failure. Clinical, laboratory and prognostic parameters were compared according to the diuretic strategy used and mortality and readmission for acute heart failure during follow-up were analyzed. Previous medical history was similar in the two groups. At admission, the continuous infusion group met criteria for worse prognosis: lower systolic blood pressure (p=0.011), more severe renal injury (p=0.008), lower left ventricular ejection fraction (p=0.016) and higher incidence of restrictive pattern of diastolic dysfunction (p=0.032). They were more often treated with vasopressors (p=0.003), inotropes (p=0.010), renal support therapy (p=0.003) and non-invasive ventilation (p<0.001). They had longer hospitalizations (p=0.014) and a higher incidence of cardiorenal syndrome (p=0.009); however, at discharge, there were no differences in renal function between the groups. In-hospital mortality was similar, and during follow-up there were no differences in mortality or readmission for acute heart failure. Continuous infusion was preferred in patients presenting with worse clinical status, in whom renal dysfunction was transiently worse. However, in-hospital mortality and creatinine at discharge were similar. Continuous infusion thus appears to counteract the initial dire prognosis of more unstable patients. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Left ventricular longitudinal systolic dysfunction is associated with right atrial dyssynchrony in heart failure with preserved ejection fraction.

    PubMed

    Bytyçi, Ibadete; Haliti, Edmond; Berisha, Gëzim; Tishukaj, Arbërie; Shatri, Faik; Bajraktari, Gani

    2016-04-01

    We aimed in this study to assess the role of longitudinal left ventricular (LV) systolic function in heart failure with preserved ejection fraction (HFpEF) in delayed intra- and interatrial conduction time. In 85 consecutive patients with HFpEF (age 60±11 years, ejection fraction [EF] ≥45%), a complete M-mode echocardiographic and tissue Doppler imaging (TDI) study was performed. The times from the onset of the P wave on the ECG to the beginning of the A' wave (PA) from the lateral and septal mitral and tricuspid annuli on TDI were recorded. The difference between these intervals gave the intra- and interatrial dyssynchrony. Based on mitral annular plane systolic excursion (MAPSE), patients were classified as having HFpEF with impaired (MAPSE ≤1.2 cm) or normal (MAPSE >1.2 cm) longitudinal systolic function. Patients with impaired MAPSE were older (p<0.001), had higher LV mass index (p<0.001), greater left atrial (LA) minimum volume (p=0.007), reduced left atrial EF (p<0.001), higher E/e' ratio (p=0.002), reduced lateral and septal e' wave (p=0.005 and p=0.006, respectively), prolonged tricuspid PA' (p=0.03) and significantly increased right atrial (RA) dyssynchrony (p=0.001) compared with normal MAPSE. MAPSE correlated with RA dyssynchrony (r=-0.40, p<0.001) but not with interatrial and LA dyssynchrony. In patients with HFpEF and impaired MAPSE, RA dyssynchrony is increased, compared to those with normal MAPSE. As patients with RA dyssynchrony are at higher risk for arrhythmia, assessment of this dyssynchrony may help to improve treatment, as well as to predict outcome in these patients. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  11. Effects of percutaneous renal sympathetic denervation on cardiac function and exercise tolerance in patients with chronic heart failure.

    PubMed

    Gao, Jun-Qing; Xie, Yun; Yang, Wei; Zheng, Jian-Pu; Liu, Zong-Jun

    2017-01-01

    Sympathetic hyperactivity, a vital factor in the genesis and development of heart failure (HF), has been reported to be effectively reduced by percutaneous renal denervation (RDN), which may play an important role in HF treatment. To determine the effects of percutaneous RDN on cardiac function in patients with chronic HF (CHF). Fourteen patients (mean age 69.6 years; ejection fraction [EF] <45%) with CHF received bilateral RDN. Adverse cardiac events, blood pressure (BP), and biochemical parameters were assessed before and six months after percutaneous operation. Patients also underwent echocardiographic assessment of cardiac function and 6-min walk test before and at six months after percutaneous operation. The distance achieved by the 14 patients in the 6-min walk test increased significantly from 152.9±38.0 m before RDN to 334.3±94.4 m at six months after RDN (p<0.001), while EF increased from 36.0±4.1% to 43.8±7.9% (p=0.003) on echocardiography. No RDN-related complications were observed during the follow-up period. In 6-month follow-up, systolic BP decreased from 138.6±22.1 mmHg to 123.2±10.5 mmHg (p=0.026) and diastolic BP from 81.1±11.3 mmHg to 72.9±7.5 mmHg (p=0.032). Creatinine levels did not change significantly (1.3±0.65 mg/dl to 1.2±0.5 mg/dl, p=0.8856). RDN is potentially an effective technique for the treatment of severe HF that can significantly increase EF and improve exercise tolerance. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Clinical and genetic diagnosis of familial hypertrophic cardiomyopathy: Results in pediatric cardiology.

    PubMed

    Cardoso, Bárbara; Gomes, Inês; Loureiro, Petra; Trigo, Conceição; Ferreira Pinto, Fátima

    2017-03-01

    Hypertrophic cardiomyopathy (HCM) is most often of autosomal dominant inheritance with incomplete penetrance and variable expression. The main purpose of family screening is to identify relatives with unrecognized HCM and to monitor those at risk for disease, in order to minimize complications and to assess risk of sudden cardiac death. The ESC and ACCF/AHA guidelines on the diagnosis and management of HCM recommend the screening of child relatives from the age of 10-12 years. We studied the outcome of clinical screening and genetic testing of child probands and relatives (<18 years of age) from families with HCM and assessed the age-related penetrance of HCM during the follow-up of these young relatives. Twenty patients from ten families were included between 2004 and 2013, consisting of three probands and 17 first-degree relatives (80% male; median age 10 years). Fourteen child relatives were mutation carriers (70%; median age eight years). Seven (50%) of the 14 mutation carriers were diagnosed with HCM at initial assessment. At-risk child relatives were defined as those with a positive mutation but a negative phenotype at enrollment. After 3.5±0.8 years of follow-up, two of the phenotype-negative mutation carriers developed HCM at 10 and 15 years of age (28% penetrance rate). The penetrance of HCM in phenotype-negative child relatives was 28% after 3.5 years of follow-up. This underlines the need for long-term monitoring of mutation carriers irrespective of the presence of a positive phenotype. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Phenotypic expression in hypertrophic cardiomyopathy and late gadolinium enhancement on cardiac magnetic resonance.

    PubMed

    Caetano, Francisca; Botelho, Ana; Trigo, Joana; Silva, Joana; Almeida, Inês; Venâncio, Margarida; Pais, João; Sanches, Conceição; Leitão Marques, António

    2014-05-01

    The prognostic value of late gadolinium enhancement (LGE) for risk stratification of hypertrophic cardiomyopathy (HCM) patients is the subject of disagreement. We set out to examine the association between clinical and morphological variables, risk factors for sudden cardiac death and LGE in HCM patients. From a population of 78 patients with HCM, we studied 53 who underwent cardiac magnetic resonance. They were divided into two groups according to the presence or absence of LGE. Ventricular arrhythmias and morbidity and mortality during follow-up were analyzed. Patients with LGE were younger at the time of diagnosis (p=0.046) and more often had a family history of sudden death (p=0.008) and known coronary artery disease (p=0.086). On echocardiography they had greater maximum wall thickness (p=0.007) and left atrial area (p=0.037) and volume (p=0.035), and more often presented a restrictive pattern of diastolic dysfunction (p=0.011) with a higher E/É ratio (p=0.003) and left ventricular systolic dysfunction (p=0.038). Cardiac magnetic resonance supported the association between LGE and previous echocardiographic findings: greater left atrial area (p=0.029) and maximum wall thickness (p<0.001) and lower left ventricular ejection fraction (p=0.056). Patients with LGE more often had an implantable cardioverter-defibrillator (ICD) (p=0.015). At follow-up, no differences were found in the frequency of ventricular arrhythmias, appropriate ICD therapies or mortality. The presence of LGE emerges as a risk marker, associated with the classical predictors of sudden cardiac death in this population. However, larger studies are required to confirm its independent association with clinical events. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  14. The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

    PubMed

    Pusuroglu, Hamdi; Cakmak, Huseyin Altug; Akgul, Ozgur; Erturk, Mehmet; Surgit, Ozgur; Akkaya, Emre; Bulut, Umit; Yildirim, Aydin

    2015-10-01

    Red cell distribution width (RDW) is a measure of variation in the size of circulating red blood cells. Recent studies have reported a strong independent relation between elevated RDW and short- and long-term prognosis in various disorders. The aim of the present study was to investigate the relationship between admission RDW-to-platelet ratio (RPR) and in-hospital and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). A total of 470 consecutive patients with a diagnosis of STEMI who underwent primary PCI were included in this prospective study. The patients were divided into two groups based on their admission RPR: high (>0.061) RPR group and low (≤0.061) RPR group. The patients were followed for adverse clinical outcomes in-hospital and for up to one year after discharge. In-hospital cardiovascular mortality, major adverse cardiovascular events (MACE), advanced heart failure and cardiogenic shock were significantly higher in the high RPR group (p<0.05). All-cause and cardiovascular mortality, MACE, fatal reinfarction, advanced heart failure, and rehospitalization for cardiac cause were more frequent in the high RPR group in one-year follow-up (p<0.05). High RPR was found to be a significant independent predictor of one-year cardiovascular mortality in multivariate analysis (p=0.003, OR: 3.106, 95% CI: 1.456-6.623). RPR is an inexpensive and readily available biomarker that provides an additional level of risk stratification beyond that provided by conventional risk parameters in predicting long-term MACE and cardiovascular mortality in STEMI. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Cardiovascular risk profile of high school students: a cross-sectional study.

    PubMed

    Rocha, Teresa; Rocha, Evangelista; Alves, Ana Catarina; Medeiros, Ana Margarida; Francisco, Vânia; Silva, Sónia; Mendes Gaspar, Isabel; Rato, Quitéria; Bourbon, Mafalda

    2014-09-01

    Disease prevention should begin in childhood and lifestyles are important risk determinants of cardiovascular disease. Awareness and monitoring of risk is essential in preventive strategies. To characterize cardiovascular risk and the relationships between certain variables in adolescents. In a cross-sectional study, 854 adolescent schoolchildren were surveyed, mean age 16.3 ± 0.9 years. Data collection included questionnaires, physical examination, charts for 10-year relative risk of mortality, and biochemical assays. In the statistical analysis continuous variables were studied by the Student's t test and categorical variables by the chi-square test and Fisher's exact test, and each risk factor was entered as a dependent variable in logistic regression analysis. Physical activity was insufficient in 81% of students. The daily consumption of soup, salad or vegetables, and fruit was, respectively, 37%, 39% and 21%. A minority (6%) took ≤ 3 and 77% took ≥ 5 meals a day. The prevalence of each risk factor was as follows: overweight 16%; smoking 13%; hypertension 11%; impaired glucose metabolism 9%; hypertriglyceridemia 9%; and hypercholesterolemia 5%. Out-of-school physical activity, hypertension and overweight were more prevalent in males (p<0.001). Females had higher levels of cholesterol (p<0.005) and triglycerides (p<0.001). A quarter of the adolescents had a relative risk score for 10-year cardiovascular mortality of ≥ 2. Overweight showed a positive association with blood pressure, changes in glucose metabolism and triglycerides, and a negative association with number of daily meals. The results demonstrate the need for action in providing and encouraging healthy choices for adolescents, with an emphasis on behavioral and lifestyle changes aimed at individuals, families and communities. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  16. Comparison between exercise performance in asthmatic children and healthy controls--Physical Activity Questionnaire application.

    PubMed

    Santos-Silva, Rita; Melo, Cláudia; Gonçalves, Daniel; Coelho, Janine; Carvalho, Fernanda

    2014-01-01

    The PAQ questionnaire (Physical Activity Questionnaire - Kowalski, Crocker, Donen) is a self-administered 7-day recall validated questionnaire that measures physical activity levels in young people. A final activity score is obtained (1 indicates low and 5 indicates high physical activity level). Our aim was to determine whether there was any difference between the level of physical activity of children with controlled allergic disease and healthy children. We used the PAQ questionnaire with a group of asthmatic children attending hospital outpatient clinic and a group of healthy children matched for age. 155 children with allergic disease (median age of 11 years; 63% males) and 158 healthy controls (median age of 10 years; 46% males) answered the questionnaire. There were no differences in the overall level of physical activity, estimated by PAQ score, between allergic and healthy children (2,40±0,7 vs 2,48±0,62; p=0,32). Performance in physical education classes and after school sports activity was found to be different between the study groups; healthy children were more active (p=0,011) and did more sports between 6 and 10 pm (p=0,036). No other statistically significant differences were found between the study groups. Despite the fact that a majority of the parents of allergic children stated that their child's disease was a barrier to physical activity, in our study there seems to be no difference between the level of physical activity of controlled asthmatic children and their healthy peers. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  17. Severe obstructive disease: similarities and differences between smoker and non-smoker patients with COPD and/or bronchiectasis.

    PubMed

    Rezende Gonçalves, J; Corso Pereira, M; Figueiras Pedreira De Cerqueira, E M; Oliveira Magro, D; Mello Moreira, M; Paschoal, I A

    2013-01-01

    Poorly reversible airflow obstruction may or may not be related to smoking. To describe patients with severe obstructive lung disease including etiology, imaging, functional aspects, systemic manifestations, and the pattern of bronchodilator response. Sixty-eight patients (age 55.9±13.7 years, FEV(1) [forced expiratory volume in one second] 31.9±10.2% predicted) underwent spirometry, evaluation of body mass composition, 6-minute walk test, X-ray, thorax high-resolution CT scanning, and clinical evaluation. Of 68 patients enrolled, 37 had chronic obstructive pulmonary disease (COPD) and 31, extensive bronchiectasis. Among COPD patients the CT scans showed emphysema in 78.4%, and bronchiectasis in 48.6%. There were no significant differences between smokers and non-smokers, except for vital capacity, significantly smaller in non-smokers (p<0.001). We found 29 and 20 volume responders (VR) according to Paré et al. (FEV(1)/FVC>1=flow responder or <1=VR) and ATS/ERS criteria, respectively. According to Paré et al. criteria, there were 18 patients with FEV(1)<30% predicted among 29 VR, and 12 with FEV(1)<30% predicted among 39 without volume response (p=0.0101). In patients with severe obstruction, smoking does not appear to be relevant in determining functional or systemic differences, and Paré et al. criteria can detect more VR. Bronchiectasis is a common finding in severe COPD. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  18. Prevalence of secondhand smoke exposure in asthmatic children at home and in the car: A cross-sectional study.

    PubMed

    Antunes, H; Precioso, J; Araújo, A C; Machado, J C; Samorinha, C; Rocha, V; Gaspar, Â; Becoña, E; Belo-Ravara, S; Vitória, P; Rosas, M; Fernandez, E

    2016-01-01

    To compare secondhand smoke exposure (SHSe) prevalence at home and inside the car between asthmatic and non-asthmatic Portuguese children. This is a cross-sectional study that assessed children's SHSe in a representative sample of nine Portuguese cities. A validated self-reported questionnaire was administered to a random sample of 4th grade students during the school year of 2010/2011. The asthma prevalence was defined by the answers to three questions regarding asthma symptoms, medication and inhaler use. We performed chi-square tests and analysed frequencies, contingency tables, confidence intervals, and odd-ratios. The self-reported questionnaire was administered to 3187 students. Asthma prevalence was 14.8% (472 students). Results showed that 32.3% of non-asthmatic children and 32.4% of asthmatic children were exposed to secondhand smoke as at least one of their household members smoked at home. The prevalence of parental smoking, smoking among fathers and smoking among mothers at home was also similar in both groups (asthmatic and non-asthmatic children). SHSe inside the car was 18.6% among non-asthmatic children and 17.9% among asthmatic children. Asthmatic and non-asthmatic children were equally exposed to secondhand smoke, because no significant differences were found between the two groups concerning the prevalence of SHSe at home and inside the car. These findings highlight the need to include SHSe brief advice in paediatric asthma management. Copyright © 2016 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  19. Acute effects of flexible pole exercise on heart rate dynamics.

    PubMed

    de Oliveira, Letícia Santana; Moreira, Patrícia S; Antonio, Ana M; Cardoso, Marco A; de Abreu, Luiz Carlos; Navega, Marcelo T; Raimundo, Rodrigo D; Valenti, Vitor E

    2015-01-01

    Exercise with flexible poles provides fast eccentric and concentric muscle contractions. Although the literature reports significant muscle chain activity during this exercise, it is not clear if a single bout of exercise induces cardiac changes. In this study we assessed the acute effects of flexible pole exercise on cardiac autonomic regulation. The study was performed on 22 women between 18 and 26 years old. We assessed heart rate variability (HRV) in the time (SDNN, RMSSD and pNN50) and frequency (HF, LF and LF/HF ratio) domains and geometric indices of HRV (RRTri, TINN, SD1, SD2 and SD1/SD2 ratio). The subjects remained at rest for 10 min and then performed the exercises with the flexible poles. Immediately after the exercise protocol, the volunteers remained seated at rest for 60 min and HRV was analyzed. We observed no significant changes in time domain (SDNN: p=0.72; RMSSD: p=0.94 and pNN50: p=0.92) or frequency domain indices (LF [nu]: p=0.98; LF [ms(2)]: p=0.72; HF [nu]: p=0.98; HF [ms(2)]: p=0.82 and LF/HF ratio: p=0.7) or in geometric indices (RRTri: p=0.54; TINN: p=0.77; SD1: p=0.94; SD2: p=0.67 and SD/SD2: p=0.42) before and after a single bout of flexible pole exercise. A single bout of flexible pole exercise did not induce significant changes in cardiac autonomic regulation in healthy women. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. Left ventricular systolic dysfunction detected by speckle tracking in hypertensive patients with preserved ejection fraction.

    PubMed

    Gonçalves, Susana; Cortez-Dias, Nuno; Nunes, Ana; Belo, Adriana; Zimbarra Cabrita, Inês; Sousa, Catarina; Pinto, Fausto J

    2014-01-01

    The spectrum of hypertensive heart disease is wide, and can include left ventricular dysfunction. The development of echocardiographic parameters to improve patient stratification and to identify early adverse changes could be clinically useful. Aim To identify subclinical left ventricular dysfunction in hypertensive subjects with preserved ejection fraction (>55%), identified by global parameters of myocardial strain on speckle tracking imaging. This was a comparative observational study of two groups of individuals: normotensive (n=20, age 59 ± 7 years, 55% male) and hypertensive (n=229, age 62 ± 12 years, 57% male). Left ventricular function was assessed by various conventional clinical and echocardiographic parameters and global longitudinal and circumferential myocardial strain. Cut-off values to detect subclinical left ventricular dysfunction were established and applied in the hypertensive group. The Student's t test, Mann-Whitney test and chi-square test were used for the comparative statistical analysis. Most hypertensive subjects (53.7%) had grade I hypertension; blood pressure was controlled in 64.9%, and 54.8% showed left ventricular structural changes. Comparison between the normotensive and hypertensive groups showed no significant differences in parameters of global longitudinal or circumferential systolic strain. Application of the cut-offs to the hypertensive group identified 35 individuals (15.3%) as having subclinical left ventricular systolic dysfunction as assessed by global longitudinal myocardial strain parameters. In this group of hypertensive patients, global myocardial strain parameters identified a group of individuals with subclinical left ventricular systolic dysfunction despite preserved ejection fraction. The clinical relevance of these findings needs to be assessed in long-term follow-up studies. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  1. Arrhythmogenic right ventricular dysplasia: Atypical clinical presentation.

    PubMed

    Marçalo, José; Menezes Falcão, Luiz

    2017-03-01

    A 67-year-old man was admitted to our hospital after episodes of syncope preceded by malaise and diffuse neck and chest discomfort. No family history of cardiac disease was reported. Laboratory workup was within normal limits, including D-dimers, serum troponin I and arterial blood gases. The electrocardiogram showed sinus rhythm with T-wave inversion in leads V1 to V3. Computed tomography angiography to investigate pulmonary embolism showed no abnormal findings. Transthoracic echocardiography (TTE) displayed massive enlargement of the right ventricle with intact interatrial septum and no pulmonary hypertension. Cardiac magnetic resonance imaging (MRI) confirmed right ventricular (RV) dilatation and revealed marked hypokinesia/akinesia of the lateral wall. Exercise stress testing was negative for ischemia. According to the 2010 Task Force criteria for arrhythmogenic right ventricular dysplasia (ARVD), this patient presented two major criteria (global or regional dysfunction and structural alterations: by MRI, regional RV akinesia or dyskinesia or dyssynchronous RV contraction and RV ejection fraction ≤40%, and repolarization abnormalities: inverted T waves in right precordial leads [V1, V2, and V3]); and one minor criterion (>500 ventricular extrasystoles per 24 hours by Holter), and so a diagnosis of ARVD was made. After electrophysiologic study (EPS) the patient received an implantable cardioverter-defibrillator (ICD). This late clinical presentation of ARVD highlights the importance of TTE screening, possibly complemented by MRI. The associated risk of sudden death was assessed by EPS leading to the implantation of an ICD. Genetic association studies should be offered to the offspring of all ARVD patients. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiography (from the MAGYAR-Healthy Study).

    PubMed

    Piros, Györgyike Ágnes; Domsik, Péter; Kalapos, Anita; Lengyel, Csaba; Orosz, Andrea; Forster, Tamás; Nemes, Attila

    2016-02-01

    Three-dimensional (3D) speckle tracking echocardiography (3DSTE) is a novel method for assessment of left atrial (LA) volumes and function without geometrical assumptions. 3DSTE allows detailed assessment of LA features including volume measurements, strain assessments and calculation of LA ejection force (LAEF). LA strain and volume-based functional parameters originate from the same 3D dataset, but assessment of LAEF requires more data including measurement of mitral annular dimensions and Doppler-derived inflow velocities. The present study was designed to find correlations between LAEF and 3DSTE-derived LA volume-based functional properties and strain parameters in healthy subjects. The study population comprised 34 randomly selected healthy subjects (age 36.1±11.2 years, 15 men) in sinus rhythm, all of whom had undergone standard two-dimensional transthoracic Doppler echocardiographic study extended with 3DSTE. Mitral annulus diameter-based LAEF correlated with global LA peak circumferential (r=0.39, p=0.02), longitudinal (r=0.32, p=0.05) and area (r=0.43, p=0.01) strain, total atrial stroke volume (r=0.30, p=0.05) and total atrial emptying fraction (r=0.31, p=0.05) characterizing (systolic) LA reservoir function and global LA 3D strain at atrial contraction (r=-0.44, p=0.01) and active atrial emptying fraction (r=0.36, p=0.04) characterizing (diastolic) LA contraction function (booster pump phase). Complex LA functional assessment can be provided by 3DSTE, including calculation of LAEF and volume-based and strain functional properties, with significant correlations between these parameters. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. Appropriate use criteria for transthoracic echocardiography at a tertiary care center.

    PubMed

    Fonseca, Paulo; Sampaio, Francisco; Ribeiro, José; Gonçalves, Helena; Gama, Vasco

    2015-12-01

    The American College of Cardiology and American Society of Echocardiography have developed appropriate use criteria for echocardiography. The objective of this study was to assess the rate of appropriate requests for transthoracic echocardiography at a Portuguese tertiary care center and to identify the factors associated with lower adherence to the appropriate use criteria. All transthoracic echocardiograms (in- and outpatient) performed over a period of one month were analyzed by two independent imaging cardiologists, who matched each request to a specific indication in the appropriate use criteria document. Overall, 799 echocardiograms were included in the analysis. In 97.5% of cases it was possible to determine an indication listed in the criteria, according to which 78.7% of classifiable echocardiograms were appropriate, 15.3% inappropriate and 6.0% of uncertain appropriateness. The most common appropriate indication (111 echocardiograms) was initial evaluation of patients with symptoms or conditions potentially related to cardiac etiology, while the main inappropriate indication (59 echocardiograms) was routine surveillance of ventricular function in patients with known coronary artery disease and no change in clinical status or cardiac exam. The proportion of inappropriate echocardiograms was significantly higher among outpatients than among inpatients (18.8 vs. 4.3%, p<0.05) and among cardiologists compared to other specialties (19.3% vs. 10.9%, p<0.05). The majority of requests for transthoracic echocardiograms at a Portuguese tertiary care center were appropriate. Requests by cardiologists and outpatient referrals presented the highest rates of inappropriateness. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. Calcific aortic stenosis and its correlation with a novel inflammatory marker, the lymphocyte/monocyte ratio.

    PubMed

    Efe, Tolga Han; Gayretli Yayla, Kadriye; Yayla, Cagri; Ertem, Ahmet Goktug; Cimen, Tolga; Erken Pamukcu, Hilal; Bilgin, Murat; Erat, Mehmet; Dogan, Mehmet; Yeter, Ekrem

    2016-11-01

    Calcific aortic valve disease, a chronic progressive disorder, is the leading cause of valve replacement among elderly patients. The lymphocyte/monocyte ratio has been recently put forward as an inflammatory marker of relevance in several cancers as well as in cardiovascular disease. This study aims to assess the correlation between severity of calcific aortic stenosis and the lymphocyte/monocyte ratio. The study retrospectively included 178 patients with a diagnosis of calcific aortic stenosis and 139 age- and gender-matched controls. The patients were divided into two groups according to the severity of aortic stenosis: mild-to-moderate and severe. An inverse correlation was discerned between the severity of the aortic stenosis process (mean gradient) and the lymphocyte/monocyte ratio (r=-0.232, p=0.002). The lymphocyte/monocyte ratio was observed to decrease as the severity of aortic stenosis increased (p<0.001) in the group with severe aortic stenosis compared with the mild-to-moderate aortic stenosis and control groups (p<0.001, p=0.005 respectively), and in the group with mild-to-moderate aortic stenosis compared with the control group (p=0.003). Multivariate regression analysis revealed that the lymphocyte/monocyte ratio was independently related to the severity of calcific aortic stenosis (p=0.003). The present study demonstrated the existence of a statistically significant inverse relationship between severity of calcific aortic stenosis and the lymphocyte/monocyte ratio. The study also revealed that the lymphocyte/monocyte ratio was significantly related to the severity of the aortic valve stenosis process. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Right atrial deformation analysis in isolated left ventricular noncompaction - insights from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study.

    PubMed

    Nemes, Attila; Domsik, Péter; Kalapos, Anita; Gavallér, Henriette; Oszlánczi, Mónika; Forster, Tamás

    2016-10-01

    Isolated left ventricular noncompaction (ILVNC) is a rare cardiomyopathy characterized by a prominent trabecular meshwork and deep intertrabecular recesses. The present study aimed to examine right atrial (RA) volumes, volume-based functional properties and strains by three-dimensional speckle-tracking echocardiography (3DSTE) in ILVNC patients. The study group consisted of 13 patients with ILVNC (mean age: 54.6±14.1 years, six male) and 23 healthy age- and gender-matched volunteers (mean age: 50.4±12.4 years, 10 male), who served as normal controls. Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all cases. Increased systolic maximum (58.2±15.3 ml vs. 40.5±11.8 ml, p=0.0004) and diastolic pre-atrial contraction (39.6±16.1 ml vs. 28.2±9.2 ml, p=0.01) and minimum (46.2±17.5 ml vs. 34.6±11.6 ml, p=0.02) RA volumes were detected in ILVNC patients. Only total (18.6±8.5 ml vs. 12.2±5.9 ml, p=0.01) and passive (12.0±13.3 vs. 5.9±3.7 ml, p=0.05) RA stroke volumes, representing features of RA reservoir and conduit phases, were increased in ILVNC; active RA stroke volume and all emptying fractions did not differ between ILVNC patients and matched controls. Moreover, global, mean segmental and regional peak strains and strains at atrial contraction showed no differences between ILVNC patients and controls. 3DSTE-derived volumetric analysis confirmed increased cyclic RA volumes in ILVNC. Only mild RA functional alterations were demonstrated in ILVNC. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Influence of gender on prognosis of acute coronary syndromes.

    PubMed

    Cabrerizo-García, José Luis; Pérez-Calvo, Juan I; Zalba-Etayo, Begoña

    2015-01-01

    Ischemic heart disease presents different features in men and women. We analyzed the relation between gender and prognosis in patients who had suffered a high-risk acute coronary syndrome (ACS). This was a prospective analytical cohort study performed at Lozano Blesa University Hospital, Zaragoza, Spain, of 559 patients diagnosed with high-risk ACS with and without ST-segment elevation according to the American College of Cardiology/American Heart Association guidelines. The sample was divided into two groups by gender and differences in epidemiologic, laboratory, electrocardiographic and echocardiographic variables and treatment were recorded. A Cox's proportional hazard model was applied and 6-month mortality was analyzed as the main variable. The median age was 65.2±12.7 years, and 21.8% were women. Baseline characteristics in women were more unfavorable, with higher GRACE scores, older age, higher prevalence of hypertension, diabetes and heart failure, lower ejection fraction and more renal dysfunction at admission. Women suffered more adverse cardiovascular events (27.9% vs. 15.8%, p=0.002). Sixty-four patients died, 18.9% of the women vs. 9.4% of the men (p=0.004). After multivariate analysis, female gender did not present an independent relation with mortality. Hemoglobin level, renal function, ejection fraction and Killip class >1 presented significant differences. Acute syndrome coronary in women has a worse prognosis than in men. Their adverse course is due to their baseline characteristics and not to their gender. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. Mortality benefit of long-term angiotensin-converting enzyme inhibitors or angiotensin receptor blockers after successful percutaneous coronary intervention in non-ST elevation acute myocardial infarction.

    PubMed

    González-Cambeiro, María Cristina; López-López, Andrea; Abu-Assi, Emad; Raposeiras-Roubín, Sergio; Peña-Gil, Carlos; García-Acuña, José; González-Juanatey, Ramón

    2016-12-01

    Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to reduce mortality after myocardial infarction (MI). Current guidelines recommend their prescription in all patients after MI. Limited data are available on whether ACEIs/ARBs still improve prognosis in the contemporary era of non-ST elevation MI (NSTEMI) management. We aimed to evaluate the mortality benefit of ACEIs/ARBs in NSTEMI patients treated successfully with percutaneous coronary intervention (PCI). We analyzed 2784 patients with NSTEMI treated successfully with in-hospital PCI. Two groups were formed based on ACEI/ARB prescription at discharge. Two propensity score (PS) analyses were performed to control for differences in covariates: one with adjustment among the entire cohort, and the other with PS matching (n=1626). The outcome variable was all-cause mortality at four-year follow-up. There were 1902 (68.3%) patients prescribed ACEIs/ARBs at discharge. When adjusted by PS, ACEI/ARB use was associated with a hazard ratio (HR) for mortality of 0.75 (0.60-0.94; absolute risk reduction [ARR] 4.0%) in the whole cohort (p=0.01). After one-to-one PS matching (n=813 in each group), the mortality rate was significantly lower in patients prescribed ACEIs/ARBs, with HR of 0.77 (0.63-0.94; ARR 3.8%) (p=0.03). In this observational study of patients with NSTEMI, all of them treated successfully by PCI, the use of ACEIs/ARBs was significantly associated with a lower risk of four-year all-cause mortality. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Performance of traditional risk factors in identifying a higher than expected coronary atherosclerotic burden.

    PubMed

    Dores, Hélder; de Araújo Gonçalves, Pedro; Ferreira, António Miguel; Carvalho, Maria Salomé; Sousa, Pedro Jerónimo; Cardim, Nuno; Marques, Hugo; Pereira Machado, Francisco

    2015-04-01

    To evaluate the performance of traditional cardiovascular (CV) risk factors in identifying a higher than expected coronary atherosclerotic burden. We assessed 2069 patients undergoing coronary CT angiography, with assessment of calcium score (CS), for suspected coronary artery disease. A higher than expected atherosclerotic burden was defined as CS >75th percentile (CS >P75) according to age and gender-adjusted monograms. The ability of traditional CV risk factors to predict a CS >P75 was assessed in a customized logistic regression model ("Clinical Score") and by the calculation of SCORE (Systemic Coronary Risk Evaluation). The population attributable risk (PAR) of risk factors for CS >P75 was calculated. The median CS was 3.0 (IQR 0.0-98.0); 362 patients had CS >P75. The median SCORE was 3.0 (IQR 1.0-4.0). With the exception of hypertension, all traditional CV risk factors were independent predictors of CS >P75: diabetes, dyslipidemia, smoking and family history (OR 1.3-2.2, p≤0.026). The areas under the ROC curves for CS >P75 were 0.64 for the Clinical Score (95% CI 0.61-0.67, p<0.001) and 0.53 for SCORE (95% CI 0.50-0.56, p=0.088). About a quarter of patients with CS >P75 were in the two lower quartiles of the Clinical Score. Altogether, the traditional risk factors explain 56% of the prevalence of CS >P75 (adjusted PAR 0.56). Despite the association of CV risk factors with a higher than expected atherosclerotic burden, they appear to explain only half of its prevalence. Even when integrated in scores, the predictive power of these risk factors was modest, exposing the limitations of risk stratification based solely on demographic and clinical risk factors. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  9. [Primary Malignant Cardiac Tumors: Surgical results].

    PubMed

    Saraiva, Joana; Antunes, Pedro Engrácia; Carvalho, Lina; Antunes, Manuel Jesus

    2016-04-01

    To characterize primary malignant cardiac tumors operated on in our center and to analyze patient survival. Between January 1994 and August 2014, 123 patients with cardiac tumors underwent surgery, of which 12 (9.8%) were primary malignant tumors - eight sarcomas (67%), three B-cell lymphomas (25%) and one epithelioid hemangioendothelioma (8.3%). The tumor affected the left atrium in five cases (42%), the right atrium in four (33%), the right ventricle in two (17%) and the pulmonary valve in one (8%). Patients' mean age was 55.4 ± 16.9 years, 67% were female and 75% presented in New York Heart Association class III-IV. Resection was complete (negative margins) in five cases and partial in seven (five sarcomas and two lymphomas), and 11 patients needed adjuvant therapy, surgery alone being curative in only one (epithelioid hemangioendothelioma). Mean follow-up was 41.7 ± 61.3 months: 24.8 ± 30.0 months (3.8-95.7) for sarcomas, 70.1 ± 118.0 months (1-206.3) for lymphomas and 91.9 months for the epithelioid hemangioendothelioma. During follow-up, 10 patients died (83%) and two were alive (17%). Overall survival at 30 days, six months, one year and two years was 91.7%, 66.7%, 58.3% and 41.7%, respectively. In the sarcoma group, 1-year and 2-year survival were 62.5% and 37.5%, respectively. Resection of primary malignant cardiac tumors, even partial, is safe, provides relief of obstructive symptoms and improves quality of life, but is rarely curative and has a low survival rate. Due to the rarity of such tumors, a multicenter database could improve knowledge and help clarify the indications for cardiac surgery as a treatment option. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Long-term impact of pre-operative physical rehabilitation protocol on the 6-min walk test of patients with adolescent idiopathic scoliosis: A randomized clinical trial.

    PubMed

    Dos Santos Alves, V L; Stirbulov, R; Avanzi, O

    2015-01-01

    Monitored physical activities in patients with adolescent idiopathic scoliosis (AIS) have been shown to improve physical performance, endurance and cardiopulmonary function and may be assessed by the 6-min walk test (6MWT). We aimed to evaluate the long-term results of the 6MWT after a rehabilitation protocol employed before surgical correction for AIS. This prospective randomized clinical trial studied the impact of a 4-month pre-operative physical rehabilitation protocol on post-operative cardiopulmonary function and physical endurance, by using the 6MWT, in patients with AIS submitted to surgical correction, comparing them to matched controls without physical rehabilitation. Studied variables were heart and respiratory rate, systolic and diastolic blood pressure, peripheral blood oxygen saturation, Borg score, and distance walked. Patients were assessed at baseline, after 4 months of rehabilitation, and 3, 6 and 12 months post-operatively. A total of 50 patients with AIS were included in the study and allocated blindly, by simple randomization, into either one of the two groups, with 25 patients each: study group (pre-operative physical rehabilitation) and control group. The physical rehabilitation protocol promoted significant progressive improvement in heart and respiratory rate, peripheral blood oxygen saturation, distance walked, and level of effort assessed by the Borg scale after surgery. Post-surgical recovery, evaluated by 6MWT, was significantly better in patients who underwent a 4-month pre-operative physical rehabilitation protocol. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  11. Intake of antioxidant nutrients and coefficients of variation in pregnant women with preeclampsia.

    PubMed

    Menezes de Oliveira, Alane Cabral; Albuquerque Santos, Arianne; Rodrigues Bezerra, Alexandra; Machado Tavares, Myrian Cicyanne; Rocha de Barros, Amanda Maria; Costa Ferreira, Raphaela

    2016-09-01

    Oxidative stress appears to play a critical role in the pathogenesis of preeclampsia. Evidence suggests that adequate intake of antioxidants can modulate this condition. The objective of this study was to assess the intake of antioxidant nutrients and coefficients of variation in pregnant women with preeclampsia. In a cross-sectional study in the public health network of the city of Maceió, Brazil, a dietary survey was performed consisting of 24-hour food recalls, with subsequent adjustment of nutrients using the estimated average requirement as the cutoff point, and a questionnaire on frequency of consumption of antioxidants. We studied 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP) with mean ages of 25.8±6.7 years and 24.1±6.2 years (p=0.519), respectively. A low mean intake of antioxidants (vitamin A, selenium, zinc and copper) was observed in both PWP and PWoP, although intakes of vitamin A (p=0.045) and selenium (p=0.008) were higher in PWoP. In addition, we observed high coefficients of variation in nutrient intakes in both groups, which were higher for vitamin C (p<0.001), vitamin A (p=0.006) and copper (p=0.005) in PWP. Consumption of antioxidant nutrients by pregnant women with preeclampsia is inadequate, with considerable daily variations in intake, which points to a need for nutrition education strategies aimed at improving intakes, because diet is without doubt a key factor in the modulation of oxidative stress caused by preeclampsia. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. [Anti-inflammatory effect of high-density lipoprotein on the cardiovascular system of hyperlipidemic mice].

    PubMed

    Garcia, José Antonio D; de Lima, Ciderléia Castro; Messora, Luiza B; Cruz, Aline F; Marques, Ana P S; Simão, Talita P; Soares, Evelise Aline; Cristina Costa Resck, M; Incerpi, Erika K; de Mello Oliveira, Nelma; dos Santos, Leandro

    2011-10-01

    LDLr-/- mice are spontaneously hyperlipidemic and resistant to the development of neointimal lesions. This study aimed to determine the factor that prevents the inflammatory process and neointimal lesions and insulin resistance in LDLr-/- mice. Three groups of 3-month-old male mice were used: wild-type mice (WT group); LDLr-/- mice fed a standard diet (S group); and LDLr-/- mice fed a high-fat diet (HF group). After 15 days, blood was collected for analysis of plasma lipids, glucose and insulin. The HOMA index was calculated to determine insulin resistance. The heart and aorta were removed for histological study. Histological sections of the heart were processed immunohistochemically with anti-CD40L antibodies to evaluate the inflammatory process. Histological sections of the aorta were stained with hematoxylin/eosin and picrosirius red to assess morphological and morphometric alterations. The S mice were resistant to the inflammatory process, as shown by low immunoreactivity to CD40L, with high plasma HDL levels, and did not develop insulin resistance, even with moderate hyperlipidemia compared to WT. The HF mice showed severe hyperlipidemia, increased cardiac immunoreactivity to CD40L, pronounced morphological changes in the aortic wall and insulin resistance, associated with a decrease in plasma HDL levels, compared to S. This severe hyperlipidemia in the HF mice can be considered the major metabolic factor inducing oxidative stress in the cardiovascular system, increasing the lipid peroxidation of HDL and hence its removal by the liver, with consequent lowering of plasma HDL levels. High HDL plasma levels are a protective factor against the development of cardiovascular inflammation and insulin resistance in LDLr-/- mice, preventing the development of neointimal lesions. Copyright © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Hypervolemia, hypoalbuminemia and mitral calcification as markers of cardiovascular risk in peritoneal dialysis patients.

    PubMed

    Querido, Sara; Quadros Branco, Patrícia; Silva Sousa, Henrique; Adragão, Teresa; Araújo Gonçalves, Pedro; Gaspar, Maria Augusta; Barata, José Diogo

    2017-09-01

    Mortality in patients with end-stage renal disease is higher than in the general population. This is linked to traditional and non-traditional cardiovascular (CV) risk factors, as well as with risk factors associated with end-stage renal disease itself. The aim of this study is to identify CV risk markers in patients beginning peritoneal dialysis (PD) and their association with CV events and CV mortality. This was a retrospective cohort study of 112 incident PD patients, in which demographic, clinical and laboratory parameters, valvular calcifications, types of PD solutions, hospitalizations, CV events and death were analyzed. Occurrence of CV events or death due to a CV event after PD initiation was defined as the primary endpoint. The use of icodextrin solution was taken as a marker of hypervolemia. Mean age was 53.7±16.1 years. Patients were treated with PD for 29.3±17.4 months. Eighteen patients (16.1%) had valvular calcifications at baseline, 15 patients (13.4%) had major CV events and 11 patients (9.8%) died from CV-related causes. Cox proportional hazards analysis of CV events or CV-related mortality revealed that mitral calcification, use of icodextrin solution and low albumin were independent predictors of CV events or mortality. Traditional CV risk factors appear to have little impact on CV complications in PD patients. Nevertheless, hypervolemia, hypoalbuminemia and mitral calcifications were independent predictors of CV events or mortality in this group of patients. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Obese patients: respiratory complications in the post-anesthesia care unit.

    PubMed

    Mendonça, J; Pereira, H; Xará, D; Santos, A; Abelha, F J

    2014-01-01

    Obesity has been associated with respiratory complications, and the majority of these complications occur in the Post-Anesthesia Care Unit (PACU). The aim of this study was to evaluate the outcome and incidence of adverse respiratory events (AREs) in obese patients during their stay in the PACU METHODS: We conducted a prospective control study that included 27 obese patients matched with an equal number of patients with body mass index (BMI)<30 (non-obese control group); the 2 groups of patients were similar in respect to gender distribution, age, and type of surgery and had been admitted into the PACU after elective surgery (May 2011). The AREs were identified during PACU stay. Descriptive analysis of variables was performed, and the Mann-Whitney U test, Chi-square test, or Fisher's exact test were used for comparisons. Associations with AREs were studied using univariate and multivariate logistic regression models. There was a higher frequency of STOP-BANG ≥3 (89% vs. 11%, P<.001) among obese patients and they were less frequently scheduled to undergo high-risk surgery (7% vs. 41%, P=.005) and major surgery (4% vs. 15%, P=.008). Obese patients had more frequent AREs in the PACU (33% vs. 7%, P<.018). Multivariate analysis identified obesity and residual neuromuscular blockade as independent risk factors for the occurrence of AREs. Stay in the PACU was longer for obese patients (120min vs. 84min, P<.01). Obesity was considered an independent risk factor for AREs in the PACU. Obese patients stayed longer in the PACU, but they did not stay longer in the hospital. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  15. Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score.

    PubMed

    Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Cambeiro-González, Cristina; Álvarez-Álvarez, Belén; Pereira-López, Eva; Gestal-Romaní, Santiago; Pedreira-López, Milagros; Rigueiro-Veloso, Pedro; Virgós-Lamela, Alejandro; García-Acuña, José María; González-Juanatey, José Ramón

    2015-06-01

    Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02-1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79 ± 0.02) and optimal fit (Hosmer-Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values. The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  16. Pneumococcal pneumonia - Are the new severity scores more accurate in predicting adverse outcomes?

    PubMed

    Ribeiro, C; Ladeira, I; Gaio, A R; Brito, M C

    2013-01-01

    The site-of-care decision is one of the most important factors in the management of patients with community-acquired pneumonia. The severity scores are validated prognostic tools for community-acquired pneumonia mortality and treatment site decision. The aim of this paper was to compare the discriminatory power of four scores - the classic PSI and CURB65 ant the most recent SCAP and SMART-COP - in predicting major adverse events: death, ICU admission, need for invasive mechanical ventilation or vasopressor support in patients admitted with pneumococcal pneumonia. A five year retrospective study of patients admitted for pneumococcal pneumonia. Patients were stratified based on admission data and assigned to low-, intermediate-, and high-risk classes for each score. Results were obtained comparing low versus non-low risk classes. We studied 142 episodes of hospitalization with 2 deaths and 10 patients needing mechanical ventilation and vasopressor support. The majority of patients were classified as low risk by all scores - we found high negative predictive values for all adverse events studied, the most negative value corresponding to the SCAP score. The more recent scores showed better accuracy for predicting ICU admission and need for ventilation or vasopressor support (mostly for the SCAP score with higher AUC values for all adverse events). The rate of all adverse outcomes increased directly with increasing risk class in all scores. The new gravity scores appear to have a higher discriminatory power in all adverse events in our study, particularly, the SCAP score. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  17. The overall impact of COPD (CAT) and BODE index on COPD male patients: correlation?

    PubMed

    Ladeira, I; Gomes, T; Castro, A; Ribeiro, C; Guimarães, M; Taveira, N

    2015-01-01

    Chronic Obstructive Pulmonary Disease (COPD) will be the 5th leading cause of disability (DALYs) and the 4th leading cause of death by 2030. Measuring the real impact of COPD using CAT ("COPD Assessment Test") can complement BODE index, an indicator of mortality. To assess correlation between CAT and BODE index in COPD patients. A retrospective study was conducted in a population of patients with COPD in a Respiratory Rehabilitation program. We analyzed demographic variables, variables in respiratory function--6 min walking test (6 MWT), post-BD forced expiratory volume in 1st second (FEV1%); dyspnea by mMRC scale; BODE Index and CAT. The study included 50 patients--GOLD stage I (7), II (25), III (14) and IV (4), 48 men; mean age 62.6 years (± 9.5), average BMI 25.8 kg/m(2) (± 4.8) and FEV1 57.1% (± 19.6); 6 MWT of 443.3m (± 61.6); 46% patients in classes 2 and 3 of mMRC scale; 84% were class 2 in BODE Index. About 80% reported slight to medium impact in CAT. CAT score and impact were correlated with BODE index score: R=0.475, p<0.01, and R=0.377, p=0.004, and BODE index class: R=0.357, p=0.011, and R=0.326, p=0.021. As pre-existent data in the literature (exacerbations and benefit of rehabilitation in COPD), the positive correlations found with BODE index reinforce the discriminative validity of CAT as a complement in the evaluation of what the true impact of COPD is on a patient's daily life. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  18. Adult bronchiolitis--a clinical and pathological interpretative classification.

    PubMed

    Madama, D; Matos, P; Franco, A; Matos, M J; Carvalho, L

    2016-01-01

    Bronchiolitis is a heterogeneous group of diseases of an inflammatory nature, centered on small conducting airways and often associated with other pulmonary disorders. No single classification scheme for bronchiolar diseases has been widely accepted. In this retrospective study, it was decided to apply a new clinical and pathological interpretative classification. To propose a new clinical and pathological interpretative classification for adult bronchiolitis, based on statistical analysis of a population of 193 patients with histopathological diagnosis of bronchiolitis. A retrospective study analyzed the epidemiological characteristics, co-morbidities and radiological findings present in a group of patients with histopathological diagnosis of bronchiolitis. This trial involved 193 cases collected over a period of eleven years; 48 (24.9%) patients had simultaneous pulmonary disease; non-pulmonary diseases, such as cardiovascular diseases, type II Diabetes mellitus and dyslipidemia were present in 57 cases. The image study was extremely important in order to integrate clinical and pathological aspects. In this study respiratory bronchiolitis related to smoking dominated. The radiological findings confirmed the secondary nature of the histopathological features, with prevalence of ground-glass patterns, pneumothorax and patterns of interstitial involvement, as described in the literature. It was also verified that clinical behavior of different forms of bronchiolitis was important to distinguish the various types, since they could progress without typical anatomopathological aspects. This trial showed that the vast majority of diagnosis obtained corresponded to bronchiolitis as secondary to pulmonary pathology. In most cases, morphological findings had to be complemented with clinical and radiological characteristics, in order to obtain the final diagnosis. Copyright © 2015 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights

  19. Different spontaneous breathing trials in patients with atrial fibrillation.

    PubMed

    Tseng, Y-H; Tseng, Y-C; Hsu, H-S; Chang, S-C

    2015-01-01

    Weaning from mechanical ventilation is one of the most important and challenging problems for most intensive care unit (ICU) patients. Spontaneous breathing trial (SBT) is the most common method used to evaluate patients' ability to breathe by themselves and plays an important role in decision making for weaning. The aim of our study was to investigate the effect of different methods of SBT in respiratory care unit (RCU) patients with atrial fibrillation (AF) on weaning outcome. We retrospectively analyzed different methods of SBT in patients with and without AF. We enrolled RCU patients who required mechanical ventilation and had undergone transthoracic echocardiography from January 2011 to January 2012. There was a higher SBT passing rate among AF patients who received pressure support ventilation (PSV) trial than in those who received T-piece trail (92.5% vs. 73.1%, p=0.041). The weaning rates between these two groups were not significantly different (83.8% vs. 94.7%, p=0.403). Total ventilator days were longer in T-piece group than in PSV group (median 40.0, IQR: 18.2-125.1 days vs. 33.0, IQR: 29.6-51.0 days respectively, p=0.580), but this difference was not statistically significant. These results were not found in patients without AF. The use of PSV trial might be considered first instead of T-piece trial for SBT when AF patients were ready to wean. Copyright © 2015 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

  20. Trends in primary angioplasty in Portugal from 2002 to 2013 according to the Portuguese National Registry of Interventional Cardiology.

    PubMed

    Pereira, Hélder; Campante Teles, Rui; Costa, Marco; Canas da Silva, Pedro; da Gama Ribeiro, Vasco; Brandão, Vítor; Martins, Dinis; Matias, Fernando; Pereira-Machado, Francisco; Baptista, José; Farto E Abreu, Pedro; Santos, Ricardo; Drummond, António; Cyrne de Carvalho, Henrique; Calisto, João; Silva, João Carlos; Pipa, João Luís; Marques, Jorge; Sousa, Paulino; Fernandes, Renato; Cruz Ferreira, Rui; Ramos, Sousa; Oliveira, Eduardo; Almeida, Manuel

    2016-01-01

    The aim of the present paper was to report trends in coronary angioplasty for the treatment of ST-elevation myocardial infarction (STEMI) in Portugal. Prospective multicenter data from the Portuguese National Registry of Interventional Cardiology (RNCI) and official data from the Directorate-General for Health (DGS) were studied to analyze percutaneous coronary intervention (PCI) procedures for STEMI from 2002 to 2013. In 2013, 3524 primary percutaneous coronary intervention (p-PCI) procedures were performed (25% of all procedures), an increase of 315% in comparison to 2002 (16% of all interventions). Between 2002 and 2013 the rate increased from 106 to 338 p-PCIs per million population per year. Rescue angioplasty decreased from 70.7% in 2002 to 2% in 2013. During this period, the use of drug-eluting stents grew from 9.9% to 69.5%. After 2008, the use of aspiration thrombectomy increased, reaching 46.7% in 2013. Glycoprotein IIb-IIIa inhibitor use decreased from 73.2% in 2002 to 23.6% in the last year of the study. Use of a radial approach increased steadily from 8.3% in 2008 to 54.6% in 2013. During the reporting period there was a three-fold increase in primary angioplasty rates per million population. Rescue angioplasty has been overtaken by p-PCI as the predominant procedure since 2006. New trends in the treatment of STEMI were observed, notably the use of drug-eluting stents and radial access as the predominant approach. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Exposure to environmental tobacco smoke in Chaves after the implementation of the law 37/2007. A cross-sectional study in two healthcare settings.

    PubMed

    Paradela, C; Pérez-Ríos, M; Ruano-Ravina, A; Barros-Dios, J M

    2013-01-01

    Environmental tobacco smoke (ETS) is currently the main indoor pollutant and causes a high morbility and mortality. A partial restriction came into force in Portugal, in 2008, law 37/2007, trying to control, define and regulate smoke-free environments. To assess exposure and perceived impact of the law 37/2007 on exposure to ETS among adults attending to the two health care facilities of Chaves (Portugal). A cross-sectional survey on tobacco consumption and exposure to ETS was undertaken in Chaves (Northern Portugal) between November 2009 and February 2010. All the patients, over 17, attending to any of the Chaves Primary Care Facilities were interviewed. Patient enrolment was done on a rolling basis covering all days of the week. A face to face interview was carried out and a carbon monoxide was measured. Prevalence and means are shown with 95% confidence intervals. 287 patients participated in the survey, 56% were males and the mean age was 54 years. Smoking prevalence was 23,6%, significantly higher in males (31% vs 17%). 46,2% reported exposure tobacco smoke elsewhere (53% in males vs. 40% in females). Smokers declared to be more exposed to ETS than non-smokers. 16.2% of the population declared to be exposed at home, 14% at work and 33% at leisure places. The highest decrease in perception of passive exposure was found for restaurants (95%). In nightclubs 68% of the participants stated that exposure has remained unchanged. The tobacco control law offered protection against tobacco smoke in several closed public spaces. However, a significant proportion of the population remains exposed. This study highlights the ineffectiveness of a partial ban. A comprehensive law is, therefore, required in Portugal. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  2. A conservative strategy in non-ST-segment elevation myocardial infarction - constraints and prognosis: The situation in Portugal.

    PubMed

    Moreira, Davide; Marmelo, Bruno; Delgado, Anne; Nunes, Luís; Pipa, João; Santos, Oliveira

    2015-05-01

    The aim of this study was to assess the impact of a conservative strategy in non-ST-segment elevation myocardial infarction in patients in the Portuguese Registry of Acute Coronary Syndromes. The 3780 patients included in the study over a three-year period were divided into three groups: group 1, patients treated by a conservative strategy during hospitalization; group 2, patients who underwent coronary angiography without percutaneous coronary intervention (PCI); and group 3, patients who underwent PCI. Clinical and procedural data and in-hospital complications were compared. The primary endpoint was defined as in-hospital or one-year mortality and the secondary endpoint as the presence of at least one of the following in-hospital complications: major bleeding according to the GUSTO criteria, need for blood transfusion, invasive ventilation, heart failure or reinfarction. Of the patients analyzed, 16.5% were treated by a conservative strategy. Patients in this group were older, more often women, and had more high-risk factors. A conservative strategy was associated with a higher rate of the primary endpoint - in-hospital mortality (10.6% vs. 1.1% vs. 0.6% in groups 1, 2 and 3, respectively, p<0.001, odds ratio (OR) 6.974, 95% confidence interval [CI]: 2.775-17.527) and one-year mortality (26.1% vs. 6.8% vs. 4.1%, p<0.001, hazard ratio (HR) 2.925, 95% CI: 1.433 -5.974) - and of the secondary endpoint - 37.2% vs. 18.9% vs. 14.6%, p<0.001; OR 1.471 95% CI: 1.043 -2.076. In this patient population, a conservative strategy is an independent predictor of in-hospital mortality, in-hospital complications and one-year mortality. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. Effects of iloprost on bleomycin-induced pulmonary fibrosis in rats compared with methyl-prednisolone.

    PubMed

    Aytemur, Z A; Hacievliyagil, S S; Iraz, M; Samdanci, E; Ozerol, E; Kuku, I; Nurkabulov, Z; Yildiz, K

    2012-01-01

    Prostacyclin (PGI2) has been shown to inhibit the expression of pro-inflammatory and pro-fibrotic mediators in pulmonary fibrosis. In this study, we aimed to test the preventive effects of intraperitoneally administered iloprost, a stable PGI2 analog, on bleomycin-induced pulmonary fibrosis in rats and to compare the effects of iloprost with the effects of methyl-prednisolone, a traditional therapy. Rats were randomly allocated into four groups: 1. Saline alone (n=6); 2. Bleomycin+placebo (n=7); 3. Bleomycin+methyl-prednisolone (n=7); 4. Bleomycin+iloprost (n=7). Fibrotic changes in the lungs were demonstrated by analyzing the cellular composition of bronchoalveolar lavage fluid, histological evaluation and lung hydroxyproline content. Fibrosis was made in the lungs of rats by bleomycin experimentally. Fibrosis scores in the methyl-prednisolone and the iloprost groups were significantly lower than in the placebo group (p<0.05). Furthermore, the score of the iloprost group was significantly lower than the score of the methyl-prednisolone group. The hydroxyproline content was significantly less in the methyl-prednisolone and the iloprost groups (p<0.05). In the placebo group, the neutrophil percentage in bronchoalveolar lavage was significantly higher than in the other groups, whereas the macrophage percentage in placebo group was significantly lower (p<0.05). Iloprost has protective effect on the pulmonary fibrosis induced by bleomycin and it may be more effective in decreasing fibrotic changes than methyl-prednisolone. Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  4. [Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer diagnosis and staging in 179 patients].

    PubMed

    Bugalho, A; Ferreira, D; Barata, R; Rodrigues, C; Dias, S S; Medeiros, F; Carreiro, L

    2013-01-01

    Linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an important minimally invasive procedure for non-small cell lung cancer (NSCLC) staging. It is also a valid method for diagnosing extraluminal lesions adjacent to the tracheobronchial tree. To evaluate our EBUS-TBNA performance regarding diagnostic yield, safety and learning curve for lung cancer diagnosis and staging. All patients undergoing EBUS-TBNA for lung cancer diagnosis or staging were included. They were divided into three different groups: paratracheal and parabronchial masses sent for diagnosis (Group 1); peripheral lung lesions with abnormal mediastinal lymph nodes sent for diagnosis and staging (Group 2); NSCLC patients sent for mediastinal staging (Group 3). The learning curve was assessed for yield, accuracy, procedure time, size and number of lesions punctured per patient. A total of 179 patients were included and 372 lesions were punctured. The overall yield and accuracy were 88% and 92.7%, respectively. In Group 1, EBUS-TBNA was performed in 48 patients and sensitivity was 86.1% and accuracy was 87.5%. For the 87 patients included in Group 2, yield was 86.7%, accuracy was 93.1% and cancer prevalence was 51.7%. The diagnostic yield and accuracy in Group 3 was 95% and 97.7% respectively. EBUS-TBNA practice led to an increase number of sites punctured per patient in a shorter time, without complications. EBUS-TBNA is an effective method for diagnosing and staging lung cancer patients. The procedure is clearly safe. Handling and performance improves with the number of procedures executed. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  5. The benefits of cardiac rehabilitation in coronary heart disease: a gender issue?

    PubMed

    Anjo, Diana; Santos, Mário; Rodrigues, Patrícia; Brochado, Bruno; Sousa, Maria João; Barreira, Ana; Viamonte, Sofia; Fernandes, Preza; Reis, António Hipólito; Lopes Gomes, José; Torres, Severo

    2014-02-01

    Coronary heart disease is the leading cause of death in women worldwide and several studies have shown that they are under-represented in cardiac rehabilitation therapy. The objectives of this study were to assess the prevalence of women in a cardiac rehabilitation program and to assess their response to this intervention. This is a retrospective study of 858 patients who attended an exercise-based cardiac rehabilitation program after an acute coronary syndrome or elective percutaneous coronary intervention, between January 2008 and December 2012. The patients were analyzed by gender, and the impact of the intervention on cardiovascular risk factors and NT-proBNP was studied. In a subgroup of 386 patients the impact on functional capacity, resting heart rate, chronotropic index and heart rate recovery was also analyzed. Only 24% of the 858 patients who attended the program were women. Women showed statistically significant improvements in all cardiovascular risk factors, NT-proBNP, functional capacity and heart rate recovery (p<0.05) after the program. There were also improvements in resting heart rate and chronotropic index, but these were not statistically significant (p=0.08 and p=0.40, respectively) and when the improvements in these two parameters were compared between genders, there was no statistically significant difference (p=0.33 and p=0.17, respectively). Only 24% of the patients attending the program were women. We found that they benefited from cardiac rehabilitation therapy, with significant improvements in cardiovascular risk factors and in most of the prognostic markers studied. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  6. Effectiveness of atrial antitachycardia pacing in the treatment of paroxysmal atrial fibrillation in patients with pacemakers.

    PubMed

    Silva, Rui; Pereira, Telmo; Martins, Vitor

    2014-12-01

    The aim of this study was to assess the effectiveness of atrial antitachycardia pacing (ATP) in the conversion of atrial tachyarrhythmia episodes, and its impact in reducing arrhythmic burden. We performed a retrospective study in the pacing laboratory of a district hospital of 57 consecutive patients implanted with a dual chamber pacemaker, capable of performing atrial antitachycardia pacing, between 2005 and 2010. The patients were divided into two groups: ATP_ON (n=24) and ATP_OFF (n=33). The follow-up period was 15 months, with data being collected at three follow-up consultations: the first at three months after implantation, the second at nine months and the last at 15 months. In this period, there were 12 428 ATP therapies of atrial tachyarrhythmias. Although there were no statistically significant differences, there was a trend in favor of the ATP_ON group, the increase in arrhythmic burden being less marked in this group. The mean percentage of ventricular apical pacing was also significantly lower in this group, which was associated with a marginally significant reduction in arrhythmic burden (p=0.06). There was a significant positive correlation between changes in the percentage of ventricular pacing and changes in arrhythmic burden (r=0.417, p=0.02). Atrial antitachycardia pacing converted 59.7% of episodes of atrial arrhythmia, but did not significantly reduce arrhythmic burden. There was a significant positive correlation between changes in the percentage of ventricular pacing and changes in arrhythmic burden. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. Mucociliary clearance and its relation with the level of physical activity in daily life in healthy smokers and nonsmokers.

    PubMed

    Proença, M; Pitta, F; Kovelis, D; Mantoani, L C; Furlanetto, K C; Zabatiero, J; Ramos, D; Ramos, E M C

    2012-01-01

    To investigate the relationship between mucociliary transport and physical activity in daily life (PADL) in smokers and nonsmokers. Fifty-two current smokers were submitted to assessment of mucociliary transport (Sacharin Transit Time, STT), carbon monoxide levels in the exhaled air, lung function and smoking history. In addition, subjects kept a pedometer worn at the waist for six days in order to determine their level of PADL (steps/day). The tests were also performed on 30 matched healthy nonsmokers who served as control group. Light smokers (≤15 cigarettes/day) had a STT of 9 (7-11) min (median [confidence interval]), which was similar to nonsmokers (8 [8-11]min; p=0.8). Both moderate (16-25 cigarettes/day) and heavy (>25 cigarettes/day) smokers had significantly higher STT (13 [11-17] min and 13 [10-21] min, respectively) than nonsmokers and light smokers (p<0.05 for all). There was no difference in the number of steps/day between any of the groups (p>0.05 for all). In the general group of smokers, STT was not significantly correlated with PADL, pack/years index, years of smoking or age (r<-0.23; p>0.09 for all). There was significant negative correlation between STT and PADL only in light smokers (r=-0.55; p=0.02) and nonsmokers (r=-0.42; p=0.02), but not in moderate and heavy smokers. In light smokers and non-smokers, better mucociliary function is associated to higher daily physical activity level, as opposed to the decreased mucociliary function observed in smokers, i.e., those with moderate and heavy cigarette consumption. Copyright © 2011 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  8. Triatoma maculata, the Vector of Trypanosoma cruzi, in Venezuela. Phenotypic and Genotypic Variability as Potential Indicator of Vector Displacement into the Domestic Habitat.

    PubMed

    García-Alzate, Roberto; Lozano-Arias, Daisy; Reyes-Lugo, Rafael Matías; Morocoima, Antonio; Herrera, Leidi; Mendoza-León, Alexis

    2014-01-01

    Triatoma maculata is a wild vector of Trypanosoma cruzi, the causative agent of Chagas disease; its incursion in the domestic habitat is scant. In order to establish the possible domestic habitat of T. maculata, we evaluated wing variability and polymorphism of genotypic markers in subpopulations of T. maculata that live in different habitats in Venezuela. As markers, we used the mtCyt b gene, previously apply to evaluate population genetic structure in triatomine species, and the β-tubulin gene region, a marker employed to study genetic variability in Leishmania subgenera. Adults of T. maculata were captured in the period 2012-2013 at domestic, peridomestic (PD), and wild areas of towns in the Venezuelan states of Anzoátegui, Bolívar, Portuguesa, Monagas, Nueva Esparta, and Sucre. The phenotypic analysis was conducted through the determination of the isometric size and conformation of the left wing of each insect (492 individuals), using the MorphoJ program. Results reveal that insects of the domestic habitat showed significant reductions in wing size and variations in anatomical characteristics associated with flying, in relation to the PD and wild habitats. The largest variability was found in Anzoátegui and Monagas. The genotypic variability was assessed by in silico sequence comparison of the molecular markers and PCR-RFLP assays, demonstrating a marked polymorphism for the markers in insects of the domestic habitat in comparison with the other habitats. The highest polymorphism was found for the β-tubulin marker with enzymes BamHI and KpnI. Additionally, the infection rate by T. cruzi was higher in Monagas and Sucre (26.8 and 37.0%, respectively), while in domestic habitats the infestation rate was highest in Anzoátegui (22.3%). Results suggest domestic habitat colonization by T. maculata that in epidemiological terms, coupled with the presence in this habitat of nymphs of the vector, represents a high risk of transmission of Chagas disease.

  9. New approaches for improving cardiovascular risk assessment.

    PubMed

    Paredes, Simão; Rocha, Teresa; Mendes, Diana; Carvalho, Paulo; Henriques, Jorge; Morais, João; Ferreira, Jorge; Mendes, Miguel

    2016-01-01

    Clinical guidelines recommend the use of cardiovascular risk assessment tools (risk scores) to predict the risk of events such as cardiovascular death, since these scores can aid clinical decision-making and thereby reduce the social and economic costs of cardiovascular disease (CVD). However, despite their importance, risk scores present important weaknesses that can diminish their reliability in clinical contexts. This study presents a new framework, based on current risk assessment tools, that aims to minimize these limitations. Appropriate application and combination of existing knowledge is the main focus of this work. Two different methodologies are applied: (i) a combination scheme that enables data to be extracted and processed from various sources of information, including current risk assessment tools and the contributions of the physician; and (ii) a personalization scheme based on the creation of patient groups with the purpose of identifying the most suitable risk assessment tool to assess the risk of a specific patient. Validation was performed based on a real patient dataset of 460 patients at Santa Cruz Hospital, Lisbon, Portugal, diagnosed with non-ST-segment elevation acute coronary syndrome. Promising results were obtained with both approaches, which achieved sensitivity, specificity and geometric mean of 78.79%, 73.07% and 75.87%, and 75.69%, 69.79% and 72.71%, respectively. The proposed approaches present better performances than current CVD risk scores; however, additional datasets are required to back up these findings. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal.

    PubMed

    Lobo, Mariana F; Azzone, Vanessa; Resnic, Frederic S; Melica, Bruno; Teixeira-Pinto, Armando; Azevedo, Luís Filipe; Freitas, Alberto; Nisa, Cláudia; Bacelar-Nicolau, Leonor; Rocha-Gonçalves, Francisco Nuno; Pereira-Miguel, José; Costa-Pereira, Altamiro; Normand, Sharon-Lise

    2017-09-01

    We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Acute upper limb ischemia, a rare presentation of giant cell arteritis.

    PubMed

    Almeida-Morais, Luís; Galego, Sofia; Marques, Nélia; Pack, Tiago; Rodrigues, Hugo; Abreu, Rodolfo; Vasconcelos, Leonor; Marques, Hugo; Sousa Guerreiro, António

    2016-04-01

    Giant cell arteritis (GCA) is a systemic large vessel vasculitis, with extracranial arterial involvement described in 10-15% of cases, usually affecting the aorta and its branches. Patients with GCA are more likely to develop aortic aneurysms, but these are rarely present at the time of the diagnosis. We report the case of an 80-year-old Caucasian woman, who reported proximal muscle pain in the arms with morning stiffness of the shoulders for eight months. In the previous two months, she had developed worsening bilateral arm claudication, severe pain, cold extremities and digital necrosis. She had no palpable radial pulses and no measurable blood pressure. The patient had normochromic anemia, erythrocyte sedimentation rate of 120 mm/h, and a negative infectious and autoimmune workup. Computed tomography angiography revealed concentric wall thickening of the aorta extending to the aortic arch branches, particularly the subclavian and axillary arteries, which were severely stenotic, with areas of bilateral occlusion and an aneurysm of the ascending aorta (47 mm). Despite corticosteroid therapy there was progression to acute critical ischemia. She accordingly underwent surgical revascularization using a bilateral carotid-humeral bypass. After surgery, corticosteroid therapy was maintained and at six-month follow-up she was clinically stable with reduced inflammatory markers. GCA, usually a chronic benign vasculitis, presented exceptionally in this case as acute critical upper limb ischemia, resulting from a massive inflammatory process of the subclavian and axillary arteries, treated with salvage surgical revascularization. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  12. Place of death in patients with amyotrophic lateral sclerosis.

    PubMed

    Escarrabill, J; Vianello, A; Farrero, E; Ambrosino, N; Martínez Llorens, J; Vitacca, M

    2014-01-01

    Amyotrophic lateral sclerosis (ALS) is a degenerative neurological disorder that affects motor neurons. Involvement of respiratory muscles causes the failure of the ventilator pump with more or less significant bulbar troubles. ALS course is highly variable but, in most cases, this disease entails a very significant burden for patients and caregivers, especially in the end-of-life period. In order to analyze the characteristics of ALS patients who die at home (DH) and in hospital (DHosp) and to study the variability of clinical practice, a retrospective medical records analysis was performed (n=77 from five hospitals). time elapsed since the onset of symptoms and the beginning of ventilation, characteristics of ventilation (device, mask and hours/day), and support devices and procedures. In all, 14% of patients were ventilated by tracheotomy. From the analysis, 57% of patients were of DH. Mean time since the onset of symptoms was 35.93±25.89 months, significantly shorter in patients who DHosp (29.28±19.69 months) than DH (41.12±29.04) (p=0.044). The percentage of patients with facial ventilation is higher in DHosp (11.4% vs 39.4%, p<0.005). DH or not is related to a set of elements in which health resources, physician attitudes and support resources in the community play a role in the decision-making process. There is great variability between countries and between hospitals in the same country. Given the variability of circumstances in each territory, the place of death in ALS might not be the most important element; more important are the conditions under which the process unfolds. Copyright © 2013 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  13. Percutaneous closure of periprosthetic paravalvular leaks: A viable alternative to surgery?

    PubMed

    Azevedo, Ana Isabel; Braga, Pedro; Rodrigues, Alberto; Santos, Lino; Melica, Bruno; Ribeiro, José; Sampaio, Francisco; Fontes-Carvalho, Ricardo; Fonseca, Marlene; Dias, Adelaide; Gama Ribeiro, Vasco

    Paravalvular leak (PVL) is a possible complication after prosthetic valve implantation. PVL can cause significant symptoms of congestive heart failure and/or hemolysis. Medical therapy is palliative and reoperation has a high mortality rate. Percutaneous transcatheter closure is a promising alternative for symptomatic patients at high surgical risk. We aim to review the efficacy and safety of percutaneous PVL closure in a consecutive series of patients referred to our center. We performed a retrospective analysis of clinical and technical procedural data of patients referred to our center for percutaneous PVL closure between January 2009 and November 2015. Twenty procedures were performed in 18 patients under general anesthesia and under transesophageal echocardiographic and radiographic guidance. Fourteen mitral PVLs were successfully treated in 13 patients and one aortic PVL in one patient. Most (eight) of the PVLs closed were in mitral bioprostheses. Two patients underwent a second intervention, which was technically successful in one. Technical success was achieved in 15 (75%) of the procedures. At discharge, median NYHA functional class decreased by one and hemolytic anemia decreased from seven cases (38.9%) to two (11.1%). Two patients had minor bleeding at the femoral vascular access site. Survival rates at six, 12 and 24 months were 77.8%, 77.8% and 61.1%, respectively. In our experience, percutaneous PVL closure was overall effective and safe. The procedure is complex and a second intervention may be necessary. Percutaneous PVL closure may be a feasible alternative for selected symptomatic patients at high surgical risk refractory to medical therapy. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Soil management system for water conservation and mitigation of global change effect

    NASA Astrophysics Data System (ADS)

    Ospina, A.; Florentino, A.; Lorenzo, V.

    2012-04-01

    One of the main constraints in rained agriculture is the water availability for plant growth which depends largely on the ability of the soil to allow water flow, infiltration and its storage. In Venezuela, the interaction between aggressive climatic conditions, highly susceptible soils and inadequate management systems have caused soil degradation which together with global change threatened the food production sustainability. To address this problem, we need to implement conservationist management strategies that improve infiltration rate, permeability and water holding capacity in soil and reduce water loss by protecting the soil surface. In order to study the impact of different management systems on soil water balance in a Fluventic Haplustept, the effects of 11 years of tillage and crops rotation management were evaluated in a long term field experiment located in Turén (Portuguesa state). The evaluated tillage systems were no tillage (NT) and conventional tillage (CT) and crop rotation treatments were maize (Zea mays)-cotton (Gossypium hirsutum) and maize-bean (Vigna unguiculata). Treatments were established in plots arranged in a randomized block design with three replicates. The gravimetric moisture content was determined in the upper 20 cm of soil, at eight different sampling dates. Results showed increased in time of the water availability with the use of tillage and corn-cotton rotation and, better protection of the soil against raindrop impact with crop residues. Water retention capacity also increased and improved structural condition on soil surface such as infiltration, storage and water flow distribution in the rooting zone. We conclude that these strategies of land use and management would contribute to mitigate the climate change effects on food production in this region of Venezuela. Key words: Soil quality; rained agriculture; plant water availability

  15. Unexpected death of a ventilator-dependent amyotrophic lateral sclerosis patient.

    PubMed

    di Paolo, M; Evangelisti, L; Ambrosino, N

    2013-01-01

    Amyotrophic lateral sclerosis (ALS) is a fatal, progressive, neurodegenerative disease and most patients affected die of respiratory compromise and/or pneumonia within 2-3 years of diagnosis. As ALS progresses, ventilator assistance is required. In the end stages of the disease, patients suffer from respiratory failure and may become ventilator-dependent. Deaths due to malfunction of mechanical ventilators are reported but there are very few forensic autopsy records. We report the case of a 69-year-old ALS female ventilator-dependent, trachostomised patient who was found dead by her husband, with the ventilator in "stand-by" mode. A forensic autopsy was performed. Samples of internal organs were taken for histological and toxicological examination. The ventilator internal memory was also analysed and tested in order to find possible malfunction. Gross examination did not reveal any sign of trauma but showed brain and lung congestion. Pulmonary histological examination revealed thickening of peribronchial interstitial space, alveolar over-distension, break of inter-alveolar walls and diffuse alveolar haemorrhages. Focal microhemorrhages were also detected in other organs. Analysis of the ventilator internal memory showed that during the night of death, there had been several voltage drops. Specific tests revealed malfunction of the internal battery which was unable to provide the necessary voltage, as a consequence the ventilator switched off, stopping ventilation. Battery malfunction reduced the volume of the ventilator alarm, which was not heard by the caregiver. Histological pattern, with acute pulmonary emphysema and focal polivisceral haemorrhages, is strongly suggestive of a death due to "acute" asphyxia. The authors also discuss the need for strict supervision and follow up of these ventilatory dependent patients and their devices. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  16. [Correlation between pulmonary function, posture, and body composition in patients with asthma].

    PubMed

    Almeida, V P; Guimarães, F S; Moço, V J R; Menezes, S L S; Mafort, T T; Lopes, A J

    2013-01-01

    Asthma may result in postural disorders due to increased activity of accessory respiratory muscles and hyperinflation. Our primary objective was to assess the correlation between pulmonary function and posture in adult patients with asthma. Secondarily, we aimed to study the correlation between body composition and body posture in this group of patients. This was a cross-sectional study including 34 patients with asthma who were subjected to postural assessment (photogrammetry), pulmonary function testing (spirometry, whole-body plethysmography, diffusing capacity for carbon monoxide, and respiratory muscle strength), and body composition estimation by means of bioelectrical impedance. Most patients were female (70.6%) with a median age of 32.5 years (range: 23-42 years old). We found a significant correlation between horizontal alignment of head (anterior view) and the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC; ρ=-0,37; P=.03), total lung capacity (TLC; ρ=0,42; P=.01), and residual volume (RV; ρ=0,45; P<.001). Bronchial obstruction and respiratory muscle strength variables also correlated with postural assessment measures on the right and left lateral views. Both body mass index and the percentage of fat mass correlated with horizontal alignment of head, horizontal alignment of the pelvis, and the frontal angle of the lower limbs. Adult patients with asthma exhibit specific postural disorders that correlate with pulmonary function and body composition. The assessment of postural variables may provide a better pulmonary rehabilitation approach for these patients. Copyright © 2012 Sociedade Portuguesa de Pneumologia. Published by Elsevier España. All rights reserved.

  17. STOP-Bang questionnaire: translation to Portuguese and cross-cultural adaptation for use in Brazil.

    PubMed

    Fonseca, Lorena Barbosa de Moraes; Silveira, Erika Aparecida; Lima, Nathalia Meireles; Rabahi, Marcelo Fouad

    2016-01-01

    To translate and perform a cross-cultural adaptation of the Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender (STOP-Bang) questionnaire so that it can be used as a screening tool for the diagnosis of obstructive sleep apnea in Brazil. Based on the principles of good practice for the translation and cross-cultural adaptation of such instruments, the protocol included the following steps: acquisition of authorization from the lead author of the original questionnaire; translation of the instrument to Brazilian Portuguese, carried out by two translators; reconciliation; back-translation to English, carried out by two English teachers who are fluent in Portuguese; review of the back-translation; harmonization; review and approval of the questionnaire by the original author; cognitive debriefing involving 14 patients who completed the questionnaire; analysis of the results; and review and preparation of the final version of the instrument approved by the review committee. The final version of the STOP-Bang questionnaire for use in Brazil showed a clarity score > 9 (on a scale of 1-10) for all of the questions. The Cronbach's alpha coefficient was 0.62, demonstrating the internal consistency of the instrument. The means and standard deviations of the age, body mass index, and neck circumference of the patients studied were 46.8 ± 11.2 years, 43.7 ± 8.5 kg/m2, and 41.3 ± 3.6 cm, respectively. The STOP-Bang questionnaire proved to be understandable, clear, and applicable. The original instrument and the translated version, cross-culturally adapted for use in Brazil, were consistently equivalent. Therefore, it can become a widely used screening tool for patients with suspected obstructive sleep apnea. Realizar a tradução e adaptação transcultural do questionário Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender (STOP-Bang) para a língua portuguesa

  18. Implementation Of A Marine Altimeter Calibration Campaign In The Area Of Ibiza Island

    NASA Astrophysics Data System (ADS)

    Martinez-Benjamin, Juan Jose; Bravo, Rogelio Lopez; Gomez, Begona Perez; Ripoll, Josep Gili; Gomez, Ana Tapia; Gonzalez, Juan Carlos; Conde, Mercedes Sanz; Gracia, Carlos

    2013-12-01

    Sea level monitoring geodetic improvements has been made in specific coastal Spanish sites as Ibiza harbour. At Ibiza site new measurements and levelling between the GPS reference station and a radar MIROS tide gauge, both from Puertos del Estado, has been made in the last years. The goal is to maintain and improve the quality of the observation of the sea level. The information is coming from Puertos del Estado www.puertos.es. The presentation is directed mainly to the description of the actual situation of the Ibiza site in preparation for a new altimeter calibration marine campaign of Jason-2 and Saral/AltiKa satellites to be made in September 2013. A description of the two geometric levelling campaigns made in June and September 2013 is included.

  19. Conceptos Basicos Sobre el Propano

    SciTech Connect

    2016-08-01

    El propano provee energia a mas de 143.000 vehiculos en los Estados Unidos y 23 millones en todo el mundo. Flotas de todos los Estados Unidos han implementado con exito el uso de vehiculos que funcionan con gas propano, y en la actualidad varios funcionan gracias a este gas, incluyendo autobuses escolares, lanzaderas y autobuses publicos, asi como tambien furgonetas, taxis, vehiculos utilizados por las fuerzas del orden, barredoras de calles y camiones para uso profesional. El propano tambien se utiliza con frecuencia en aplicaciones fuera de la carretera, tales como montacargas, podadoras y equipos de uso profesional y otros equipos agricolas. Las ventajas del propano incluyen la disponibilidad interna, su rendimiento y el hecho de que genera menos emisiones de gases contaminantes que otras alternativas energeticas.

  20. ?`Es necesario calcular detalladamente funciones de partición atómicas?

    NASA Astrophysics Data System (ADS)

    Milone, L. A.; Merlo, D. C.

    Basándonos en extensos y precisos cómputos de funciones de partición realizados por nosotros para distintos átomos, se muestra que en el cálculo u obtención de ciertas magnitudes (notablemente la presión electrónica, la abundancia de un elemento deducida a partir de un estado fuertemente ionizado, etc.) el error porcentual que se comete es pequeño (inferior a 1 %) si se adopta, como valor de la función de partición, el peso estadístico del término correspondiente al estado fundamental del átomo. Esta notable simplificación acelera el cálculo, por ejemplo, de un modelo de atmósfera estelar, sin disminuir la precisión de los resultados.