Osteoporosis in Paediatric Patients with Spina Bifida

The prevalence andmorbidity associated with osteoporosis and fractures in patients with spina bifida (SB) highlight the importance of osteoporosis prevention and treatment in early childhood; however, the issue has received little attention. The method for the selection of appropriate patients for drug treatment has not been clarified. Objective: To review the literature concerning fracture risks and low bone density in paediatric patients with SB. We looked for studies describing state-of-the-art treatments and for prevention of secondary osteoporosis. Methods: Articles were identified through a search in the electronic database (PUBMED) supplemented with reviews of the reference lists of selected papers. The main outcome measures were incidence of fractures and risk factors for fracture, an association between bone mineral density (BMD) and occurrence of fracture, risk factors of low BMD, and effects of pharmacological and non-pharmacological treatments on BMD and on the incidence of fractures. We considered as a secondary outcome the occurrence of fractures in relation to the mechanism of injury. Results: Results indicated that patients with SB are at increased risk for fractures and low BMD. Risk factors that may predispose patients to fractures include higher levels of neurological involvement, non-ambulatory status, physical inactivity, hypercalciuria, higher body fat levels, contractures, and a previous spontaneous fracture. Limitations were observed in the number and quality of studies concerning osteoporosis prevention and treatment in paediatric patients with SB. The safety and efficiency of drugs to treat osteoporosis in adults have not been evaluated satisfactorily in children with SB

Thermal inactivation of Byssochlamys nivea in pineapple nectar combined with preliminary high pressure treatments

Byssochlamys nivea is a thermal resistant filamentous fungi and potential micotoxin producer. Recent studies have verified the presence of ascospores of such microorganism in samples of pineapple nectars. Although the majority of filamentous fungi have limited heat resistance and are easily destroyed by heat, Byssochlamys nivea ascospores have shown high thermal resistance. The aim of this work was to evaluate the application of linear and Weibull models on thermal inactivation (70, 80 and 90ºC) of Byssochlamys nivea ascospores in pineapple nectar after pretreatment with high pressure (550MPa or 650MPa during 15min). Following the treatments, survival curves were built up for each processing temperature and adjusted for both models. It was observed that survival curves at 90°C after high pressure pretreatment at 550 MPa/15 min did not fit well to linear and Weibull models. For all the other treatments, the Weibull model presented a better fit. At 90ºC without pressure treatment, the Weibull model also showed a better adjustment, having a larger R2 and a smaller RMSE. Regarding the process effectiveness, a 5-log reduction (t5), as recommended for pasteurization, was only achieved for Byssochlamys nivea ascospores presented in pineapple nectar at 90ºC/10.7 min with previous high pressure treatment of 650 MPa for 15 min. Considering the high intensity and energy demanding process with possibly product damage, other preventive and alternative treatments are being investigated

Fractures in Children and Adolescents with Spina Bifida: The Experience of a Portuguese Tertiary-Care Hospital

AIM: The morbidity associated with osteoporosis and fractures in children and adolescents with spina bifida highlights the importance of osteoporosis prevention and treatment in these patients. The aim of this study was to examine the occurrence and pattern of bone fractures in paediatric patients with spina bifida. METHOD: We reviewed the data of all paediatric patients with spina bifida who were treated in our centre between 1999 and 2008. RESULTS: One hundred and thirteen patients were included in the study (63 females, 50 males; mean age 10y 8mo, SD 4y 10mo, range 6mo-18y). The motor levels were thoracic in six, upper lumbar in 22, lower lumbar in 42, and sacral in 43 patients. Of the 113 patients, 58 (51.3%) had shunted hydrocephalus. Thirty-six (31.8%) were non-ambulatory (wheelchair-dependent [unable to self-propel wheelchair] n=3, wheelchair-independent [able to self-propel wheelchair] n=33), 13 were partial ambulators, 61 were full ambulators, and three were below the age of walking. Forty-five fractures were reported in 25 patients. The distal femur was the most common fracture site. Statistical analyses showed that patients with higher levels of involvement and in wheelchairs had a significantly increased risk of having a [corrected] fracture (p<0.001). Spontaneous fractures were the principal mechanism of injury, and an association was identified between fracture mechanism, type of ambulation, and lesion level: the fractures of patients with higher levels of motor functioning and those in wheelchairs were mainly pathological (p=0.01). We identified an association between risk of a second fracture, higher motor level lesion, and non-ambulation. There was an increased risk of having a second fracture after a previous spontaneous fracture (p=0.004). INTERPRETATION: Data in this study indicate a high prevalence of fractures in patients with spina bifida

Refletindo os multiusos nos Mares Europeus

A secção UAciência é coordenada pelo Professor Universitário Armindo Rodrigues.[…] O Ordenamento do Espaço Marítimo (OEM) é um processo de análise da localização espacial e da distribuição temporal das atividades humanas em áreas marinhas, de forma a atingir objetivos ecológicos, económicos e sociais. O ordenamento destas atividades constitui um pilar fundamental da politica marítima da União Europeia. Em Portugal, a Estratégia Nacional para o Mar, para o período de 2013-2020, procura o desenvolvimento sustentável dos sectores económicos relacionados com o mar, ao promover o desenvolvimento dos usos marítimos e a compatibilização entre os mesmos, principalmente os estratégicos do Crescimento Azul: energia, aquacultura, turismo, recursos minerais marinhos e biotecnologia azul. […].info:eu-repo/semantics/publishedVersio

Cost Evaluation During 2002 in a Medicine/Immunodeficiency Hospital Outpatient Attendance

O consumo de recursos económicos com a Saúde é uma preocupação constante dos governantes, dos administradores hospitalares e também dos profissionais de Saúde, sendo a área do seguimento/tratamento dos doentes infectados pelo Vírus da Imunodeficiência Humana (VIH) apontada como uma das que mais recursos consome. Os AA procuraram, pela avaliação dos doentes seguidos na Consulta de Medicina/Imunodeficiência do Hospital de Santo António dos Capuchos durante o período de um ano (2002), aferir de forma concreta os custos de funcionamento da mesma. Material e Métodos: Foram avaliados os utentes da Consulta de Medicina/Imunodeficiência do Hospital de Santo António dos Capuchos (HSAC) que nela compareceram, pelo menos, duas vezes durante o ano de 2002. O cálculo dos custos das consultas e dos exames complementares de diagnóstico baseou-se nos valores definidos nos Grupos de Diagnósticos Homogéneos (GDHs). O custo da terapêutica anti-retroviral foi calculado segundo os valores que nos foram fornecidos pela Farmácia do Hospital e assumindo o fornecimento mensal da mesma. Resultados: Foram avaliados 107 doentes correspondendo a 498 consultas (€11.424). Fizeram-se 244 determinações de carga viral €(24.321) e 245 estudos de subpopulações linfocitárias (€15.445). As restantes análises custaram €36.586. Dos 107 doentes, 85 estavam sob terapêutica anti-retroviral, com 3 ou 4 fármacos, tendo sido gasto, em média e por doente, €7.122. Foi necessário o internamento de 18 doentes, num total de 219 dias (€41.699). Conclusão: O custo médio anual por doente foi de €6.408

Acacia saligna (Labill.) H. Wendl in the Sesimbra county: invaded habitats and potential distribution modeling

The aim of this study is to establish the spatial pattern of colonization and spread of Acacia saligna by predictive modeling, susceptibility evaluation and to perform a cost-effective analysis in two sites of community importance (Fernão Ferro/Lagoa de Albufeira and Arrábida/Espichel) in the Sesimbra County. The main goal is to increase the knowledge on the invasive process and the potential distribution of the Acacia saligna in Sesimbra County, namely in the Natura 2000 sites. The Artificial Neural Networks model was developed in Open Modeller to predict the potential of occurrence of A. saligna, and is assumed to be conditioned by a set of limiting factors that may be known or modeled. The base information includes a dependent variable (present distribution of specie) and several variables considered as conditioning factors (topographic variables, land use, soils characteristics, river and road distance), organized in a Geographical Information System (GIS) database. This is used to perform spatial analysis, which is focused on the relationships between the presence or absence of the specie and the values of the conditioning factors. The results show a high correspondence between higher values of potential of occurrence and soils characteristics and distance to rivers; these factors seem to benefit the specie’ invasion process. According to the conservation value of each cartographic unit, related to natural habitats included in Habitats Directive (92/43/EEC), the coastal habitats (2130, 2250 and 2230) were the most susceptible to invasion by A. saligna. The predicted A. saligna distribution allows for a more efficient concentration and application of resources (human and financial) in the most susceptible areas to invasion, such as the local and national Protected Areas and the Sites of Community Importance, and is useful to test hypotheses about the specie range characteristics, habitats preferences and habitat partitioning

An approach to ecosystem-based management in maritime spatial planning process

Sustainable development is the framing concept assuring that resources are exploited while maintaining the ability of these natural resources to provide for future generations. With human dependence on marine resources increasing, Ecosystem-Based Management (EBM) has been identified as a suitable approach to ensure sustainable development. In order to achieve this, the core principles and elements of EBM should be operational in the maritime/marine spatial planning (MSP) process to ensure that human activities in marine space are ordered to attain ecological, economic and social objectives. However, policies from various states and organizations sometimes do not set a clear precedence for translating principles of EBM and present different and complex approaches to an ecosystem-based marine spatial planning (EB-MSP). Again, a feasible methodology for EBM to be operational in MSP is still vague. This paper therefore presents results from a survey and review of MSP initiatives in Europe, Asia and the Americas. Results showed that essential MSP steps and elements such as adaptive management, setting of planning boundaries, understanding and analysing the ecosystem and future conditions are not fully operational. This paper focuses on a methodology for EB-MSP and gives recommendations on how to ensure that EBM is operational at each stage of an MSP process. It stresses the importance of setting planning boundaries beyond jurisdictional borders to consider bio/eco-regions and cover near-shore waters, the need to have a cross-sector integration, understanding the ecosystem through having an ecosystem service perspective and having a legal framework to ensure that results from monitoring and evaluating of plans are adapted through review and revision