Alternativas na Colocação de Cateteres em Hemodiálise

Background: Although vascular access is essential for adequate haemodialysis delivery, the systematic use of a patient's venous patrimony may eventually lead to exhaustion of suitable sites for placement of a new vascular access. Case Report: We present two cases of such patients. In the first one we inserted a 55cm catheter through the left external iliac vein, and a 40cm translumbar catheter was placed in the second one. Both interventions were performed percutaneously under radiological guidance. Both patients were anticoagulated after the procedure. Conclusion: Unusual sites for haemodialysis catheter placement may be life saving in selected situations and offer safe and viable alternatives for adequate haemodialysis delivery

Efficacy of Percutaneous Transluminal Angioplasty on Dysfunctional Fistulae Because of Inflow Stenosis

PURPOSE: Autogenous fistulas are the preferential vascular access for hemodialysis. The aim of this retrospective study was to determine the efficacy of angioplasty for dysfunctional fistulas because of inflow dysfunction. 
 METHODS: We reviewed all the angiographic procedures performed on our institution between April 2007 and April 2009. Procedures performed in dysfunctional fistulas because of inflow stenoses were analyzed. Fistulas with stenoses out of these areas were excluded. The following data were collected: patient age and sex, fistula age at the time of intervention, location of fistula, number and location of stenosis, angiography referral criteria, clinical findings (presence or absence of thrills, bruits and pulsatility) and date of reintervention or failure. 
 RESULTS: During the study period 215 fistulas were submitted to angiography of which, seventy-one presented inflow stenosis (33%). Mean follow-up was 21.72±9.26 months, and average age was 7.03 months. Two groups were considered: 31 fistulas comprising ≤6 months old, and 40 fistulas >6 months old. Primary patency rates±SE for older fistulas at 6, 12, 18 and 24 months, respectively, was 91.3%± 0.04%, 80.7%± 0.07%, 53.8% ±0.10% and 34.2±0.1% versus 91.7±0.08%, 57.1±0.14%, 23±0.14%, 11.4%± 0.1% for younger fistulas (P=0.04). Fistulas ≤6 months old and multiple stenosis were associated with a poorer primary patency rate (P=0.005).
 CONCLUSIONS: Inflow stenosis is frequently associated with fistula dysfunction. In this study we only analyzed AVF with inflow stenosis and we have shown that angioplasty can have great patency results, particularly for single lesions in matured fistulas.info:eu-repo/semantics/publishedVersio

Treatment of Hepatitis C Virus Infection in Kidney Transplant Recipients: Case Report

Chronic hepatitis C virus (HCV) infection exists in a large proportion of patients undergoing renal transplantation. Nowadays it is not considered to be an absolute contraindication to transplantation; however, it is associated with an increased risk for the patient and accounts for a shorter half-life of the renal allograft. We present three transplant recipients who displayed serious hepatic dysfunction after renal transplantation due to an HCV infection. In two of these cases, the liver biopsies established the diagnosis of FCH. In the third case, the liver biopsy was compatible with the early stages of FCH. All patients were started on peg-interferon alfa 2-b and ribavirin with subsequent normalization of hepatic function and early complete viral responses

A rede dos centros locais de aprendizagem da Universidade Aberta ao serviço de desenvolvimento social e territorial em Portugal

Os Centros Locais de Aprendizagem (CLA) da Universidade Aberta (UAb) são núcleos que, a par das Delegações, integram os serviços desconcentrados desta Universidade. Fazem parte da sua estrutura orgânica e têm estado em funcionamento progressivamente desde setembro de 2008. Neste texto apresentamos os atuais eixos que sustentam o seu programa de trabalho e as principais linhas estratégicas de ação desta rede no futuro no ano em que comemora dez anos de existência.info:eu-repo/semantics/publishedVersio

A Study on the Effects of Unwanted Air Infiltration on Thermal Comfort at an Airport Terminal

The Energy Systems Laboratory at Texas A&M University is currently studying ways to make improvements in thermal comfort at the Terminal E building at DFW airport. Airport terminal building HVAC systems are generally known to consume large amounts of energy to provide an environment that is comfortable for the employees and travelers. Wind direction, the shape and orientation of the building with respect to the prevailing wind can have a deleterious effect on the HVAC system ability to provide the comfort levels that people have become accustomed to in public buildings. Airport terminal buildings, such as the one in this study, built before the current energy awareness that is prevalent today have many problems associated with air infiltration primarily due to openings in the building structure to permit a smooth flow of passengers and luggage toward their destination. Entry ways that allow for easy egress generally use sliding door vestibules that are self closing based on sensors and timers to provide the building user an unimpeded path into and out of the building. During peak traffic periods, these doors are open for relatively long periods of time and can cause significant loss of building pressure. If the shape of the terminal building is such that the gate doors to the aircraft are opposing the egress entryways, air flows can develop within the building that blow across the width of the building, causing drafts that can either be cold or hot based on the outside air temperature. The shape of the building in this study is C-shaped with the opening of the “C” facing toward the West. Weather data will be analyzed along with hot and cold calls within the terminal building to correlate the effect of wind direction on indoor thermal comfort. Unwanted air infiltration flow pathways will be identified using smoke testers and analyzed with efforts to reduce entry into the building envelope

Osteoarthritis:Mechanistic Insights, Senescence, and Novel Therapeutic Opportunities

Osteoarthritis (OA) is the most common joint disease. In the last years, the research community has focused on understanding the molecular mechanisms that led to the pathogenesis of the disease, trying to identify different molecular and clinical phenotypes along with the discovery of new therapeutic opportunities. Different types of cell-to-cell communication mechanisms have been proposed to contribute to OA progression, including mechanisms mediated by connexin43 (Cx43) channels or by small extracellular vesicles. Furthermore, changes in the chondrocyte phenotype such as cellular senescence have been proposed as new contributors of the OA progression, changing the paradigm of the disease. The use of different drugs able to restore chondrocyte phenotype, to reduce cellular senescence and senescence-associated secretory phenotype components, and to modulate ion channel activity or Cx43 appears to be promising therapeutic strategies for the different types of OA. In this review, we aim to summarize the current knowledge in OA phenotypes related with aging and tissue damage and the new therapeutic opportunities currently available

Esterilização tubária histeroscópica com Essure ® : um estudo observacional de 7 anos

Introduction: Hysteroscopic sterilization with the Essure® device is a method of contraception considered safe and effective already applied in more than 200,000 women. This study aims to evaluate the efficacy of this method of contraception and the adverse events associated with the placement of Essure®, including pain during the procedure and postprocedure complications. Material and methods: We performed a retrospective observational study with inclusion of all the women submitted to Essure® placement in a large urban hospital in Portugal, from January 2008 to December 2015 (7 years). The variables age, parity, duration and intercurrences of the procedure, follow-up exams and final outcome were evaluated. The statistical analysis was performed with STATA 12.1. Results: Of the 118 women only 100 finished the procedure with 16.9% reporting moderate or severe pain. Although less than 3 intrauterine rings were found in 8.5% of cases, the success rate was 92%. The complications described were tubal perforation (0.8%), pregnancy (1 case) and incorrect positioning of the implants (3%). Discussion/Conclusion: The success rate of the procedure was very close to that described in the literature with a low incidence of complications. That advantages make it an idea method for women with high surgical risk and multiple co-morbiditiesinfo:eu-repo/semantics/publishedVersio

Physiotherapists’ barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice in patients at risk of recurrence of low back pain: a qualitative study

Background: Recurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists' perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain. Methods: Two focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements. Results: In total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists' implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources. Conclusions: This study identified modifiable barriers and facilitators to physiotherapists' implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.info:eu-repo/semantics/publishedVersio

Bone Densitometry Versus Bone Histomorphometry in Renal Transplanted Patients: A Cross‐Sectional Study

Bone loss leads to increase risk of fractures in renal transplantation. The aim of this study was to analyse the relationship between bone densitometry (DXA) findings, bone histomorphometry and bone-related molecules 1-year after renal transplantation. We performed a cross-sectional study of de novo renal transplanted patients that agreed to perform a bone biopsy and a DXA examination 1 year after transplantation. All patients underwent a laboratory evaluation, bone biopsy, DXA examination and cardiac CT 1 year after transplantation. 67 patients were included, 16 had a normal examination, and 18 patients were classified as having osteoporosis by DXA. Correlations between bone mineral density and T-scores of total femur and femoral neck were the ones that best correlated with bone volume assessed by a bone biopsy. The sensitivity of DXA for osteoporosis diagnosis was 47.0%, and the specificity was 81.2%. The positive predictive value was 50.0%, and the negative predictive value (NPV) was 80.0%. DXA parameters also correlated with klotho and sclerostin serum levels. In this population, a normal examination excluded the presence of osteoporosis, helping in identifying patients that would not benefit from therapy. Overall, densitometry in total femur and femoral neck correlated well with bone volume measured by bone biopsy.info:eu-repo/semantics/publishedVersio