Bloqueio Aurículo-Ventricular Completo Congénito. Caso Clínico e Revisão da Literatura

Introduction: Congenital complete atrioventricular block (AVB) without cardiac malformation is a rare and potentially fatal condition. In most cases it is associated with maternal systemic lupus erythematosus through transplacental passage of antibodies anti-SSA/Ro and/or anti-SSB/La. Antenatal fluorinated-steroids have been successful in reversing first and second degree congenital AVB but inconsistent in third degree block. Case Report:The authors report a case of fetal bradycardia diagnosed at 24 weeks of gestation. The fetal echocardiogram revealed a second/third degree AVB without structural heart disease. Maternal anti-SSA/Ro antibodies were detected. There was no blockage improvement with maternal oral fluorinated-steroids. An elective cesarean section was performed at term with the delivery of a healthy girl that required an epicardical pacemaker on the 8th day of life. Conclusion: In this case, treatment with maternal fluorinated corticosteroids was not effective in preventing progression of the heart block

Chronic Hypertension with Gestational Diabetes Mellitus: What About Complications?

The aim of this study was to evaluate the impact of chronic hypertension and gestational diabetes on pregnancy outcomes. We conducted a historical cohort study of 334 women undergoing singleton births in a Portuguese tertiary care center in Lisbon during 2012. Women were categorized into gestational diabetes mellitus with or without chronic hypertension. Pregnancy outcomes were compared using nonparametric tests. Multivariable analysis was used to control for potential confounders. The rate of preeclampsia in women with both chronic hypertension and gestational diabetes was 26.8% versus 3.8% in women with only gestational diabetes (p<0.05). Preterm birth was significantly more frequent in women with diabetes and chronic hypertension, 22.9% versus 9.7%, compared with women who only had gestational diabetes (p<0.05). The rate of newborns small for gestational age in women with the two conditions was 19.1% versus 7.6% in women with only gestational diabetes (p<0.05), but the rate of large for gestational age newborns in women of chronic hypertension and gestational diabetes was 9.6% versus 3.8% in gestational diabetes (p<0.05). The impact of having both chronic hypertension and gestational diabetes in pregnancy leads to poor pregnancy and perinatal outcomes, represented by more maternal, obstetrical and neonatal morbidity.info:eu-repo/semantics/publishedVersio

Hyperthyroidism in Pregnancy - Case Report

Thyroid disease is common in pregnant women.We report a 10 weeks gestation pregnancy with hyperemesis gravidarum, hypertension crisis and hyperthyroidis

Combined use of O3/H2O2 and O3/Mn2+ in flotation of dairy wastewater

This work investigated the degradation of organic matter present in synthetic dairy wastewater by the combination of ozonation (ozone (O 3 )/hydrogen peroxide (H 2 O 2 )) and catalytic ozonation (ozone (O 3 )/manganese (Mn 2+ )) associated with dispersed air flotation process. The effect of independent factors such as O 3 concentration, pH and H 2 O 2 and Mn 2+ concentration was evaluated. For the flotation/O 3 /H 2 O 2 treatment, the significant variables (p ≤ 0.05) were: O 3 concentration (linear and quadratic effect), H 2 O 2 concentration linear and quadratic effect, pH values (linear and quadratic effect) and interaction O3 concentration versus pH. For catalytic ozonation, it was observed that the significant variable was the linear effect of O 3 concentration. According to the desirability function, it was concluded that the optimal condition for the treatment of flotation/O 3 /H 2 O 2 can be obtained in acidic solution using O3 concentrations greater than 42.9 mg L -1 combined with higher concentrations of H 2 O 2 to 1071.5 mg L -1 . On other hand, at pH values higher than 9.0, the addition of O3 may be neglected when using higher concentrations than 1071.5 mg L -1 of H 2 O 2 . For flotation/ozonation catalyzed by Mn 2+ , it was observed that metal addition did not affect treatment, resulting in an optimum condition: 53.8 mg L -1 of O 3 and pH 3.6

Tectonic and lithological controls on fluvial landscape development in Central-Eastern Portugal: Insights from long profile tributary stream analyses

This study examines the long profiles of tributaries of the Tagus and Zêzere rivers in Portugal (West Iberia) in order to provide new insights into patterns, timing, and controls on drainage development during the Quaternary incision stage. The studied streams are incised into a relict culminant fluvial surface, abandoned at the beginning of the incision stage. The streams flow through a landscape with bedrock variations in lithology (mainly granites and metasediments) and faulted blocks with distinct uplift rates. The long profiles of the analyzed streams record an older transitory knickpoint/knickzone separating (1) an upstream relict graded profile, with lower steepness and higher concavity, that reflects a long period of quasi-equilibrium conditions reached after the beginning of the incision stage, and (2) a downstream rejuvenated long profile, with steeper gradient and lower concavity, particularly for the final reach, which is often convex. The rejuvenated reaches testify to the upstream propagation of several incision waves, interpreted as the response of each stream to increasing crustal uplift and prolonged periods of base-level lowering by the trunk drainages, coeval with low sea level conditions. The morphological configurations of the long profiles enabled spatial and relative temporal patterns of incisions to be quantified. The incision values of streams flowing on the Portuguese Central Range (PCR; ca. 380–150 m) are variable but generally higher than the incision values of streams flowing on the adjacent South Portugal Planation Surface (SPPS; ca. 220–110 m), corroborating differential uplift of the PCR relative to the SPPS. Owing to the fact that the relict graded profiles can be correlated with the Tagus River T1 terrace (1.1–0.9 My) present in the study area, incision rates can be estimated (1) for the streams located in the PCR, 0.38–0.15 m/ky and (2) for the streams flowing on the SPPS, 0.22–0.12 m/ky. The differential uplift inferred in the study area supports the neotectonic activity of the bordering faults, as proposed in previous studies based upon other geological evidence

Exploring regression dilution bias using repeat measurements of 2858 variables in ≤49 000 UK Biobank participants

BACKGROUND: Measurement error in exposures and confounders can bias exposure-outcome associations but is rarely considered. We aimed to assess random measurement error of all continuous variables in UK Biobank and explore approaches to mitigate its impact on exposure-outcome associations. METHODS: Random measurement error was assessed using intraclass correlation coefficients (ICCs) for all continuous variables with repeat measures. Regression calibration was used to correct for random error in exposures and confounders, using the associations of red blood cell distribution width (RDW), C-reactive protein (CRP) and 25-hydroxyvitamin D [25(OH)D] with mortality as illustrative examples. RESULTS: The 2858 continuous variables with repeat measures varied in sample size from 109 to 49 121. They fell into three groups: (i) baseline visit [529 variables; median (interquartile range) ICC = 0.64 (0.57, 0.83)]; (ii) online diet by 24-h recall [22 variables; 0.35 (0.30, 0.40)] and (iii) imaging measures [2307 variables; 0.85 (0.73, 0.94)]. Highest ICCs were for anthropometric and medical history measures, and lowest for dietary and heart magnetic resonance imaging.The ICCs (95% confidence interval) for RDW, CRP and 25(OH)D were 0.52 (0.51, 0.53), 0.29 (0.27, 0.30) and 0.55 (0.54, 0.56), respectively. Higher RDW and levels of CRP were associated with higher risk of all-cause mortality, and higher concentration of 25(OH)D with lower risk. After correction for random measurement error in the main exposure, the associations all strengthened. Confounder correction did not influence estimates. CONCLUSIONS: Random measurement error varies widely and is often non-negligible. For UK Biobank we provide relevant statistics and adaptable code to help other researchers explore and correct for this

Degradation kinetics of organic matter in dairy industry wastewater by flotation/ozonation processes

This study evaluated the adjustment of four kinetic models and their respective parameters on data of dairy wastewater treatment by the physico-chemical process of flotation and ozonation. The experiment was implemented during the year 2014, with all the tests in triplicate. The treatments were carried out at different pH levels (3.6, 7.0 and 10.4), and flotation/ozonation was catalyzed by manganese (Mn2+) in neutral level (pH 7.0). Best removal efficiencies for chemical oxygen demand (COD) were obtained in acidic medium, with removals greater than 75% after 20 min of treatment. There was no significant difference with regards to addition of Mn2+on COD removal by the physico-chemical process. The kinetic models that best fit to the experimental data, for all treatments, were the asymptotic (residual) model and that of Chan and Chu. Treatment in acidic medium showed the highest values of the kinetic parameters for the adjusted model, obtaining a k coefficient equal to 0.2394 min-1for the asymptotic model and kinetic coefficient 1/ρ of 0.4816 min-1for the Chan and Chu model, both presenting a determination coefficient greater than 99%