A colonoscopia virtual no rastreio do cancro colo rectal

O cancro colo - rectal (CCR) é um problema de saúde mundial, estando associadas elevadas taxas de mortalidade e morbilidade. A maioria de CCR deriva de pólipos adenomatosos.. Um estudo retrospectivo, efectuado no serviço de Radiologia, dos achados imagiológicos típicos e atípicos, entre Janeiro de 2008 e Junho 2010. A Colonoscopia Virtual, apresenta uma sensibilidade elevada na detecção de lesões, com dimensão superior a 10mm, permitindo um diagnóstico precoce, é um exame rápido, pouco invasivo, não há necessidade de sedação e é efectuada em ambulatório.The colorectal cancer (CCR) is a health problem worldwide, being associated with high rates of mortality and morbidity. The majority CRC will be develop from adenomatous polyps. The retrospective study, carried out in the Radiology Department and having reviewed the imaging of typical and atypical findings, between January 2008 and June, 2010. The Virtual Colonoscopy presents a high sensibility in detecting lesions, larger then 10mm, allowing early diagnosis. In addition is a rapid examination, little invasive, patients do not need sedation, and can be performed at ambulatory

Dual source/dual energy-renal applications

Development of Dual Source Computed Tomography (Definition, Siemens Medical Solutions, Erlanger, Germany) allowed advances in temporal resolution, with the addition of a second X-ray source and an array of detectors to the TCM 64 slices. The ability to run exams on Dual Energy, allows greater differentiation of tissues, showing differences between closer attenuation coefficients. In terms of renal applications, the distinction of kidney stones and masses become one of the main advantages of the use of dual-energy technology. This article pretends to demonstrate operating principles of this equipment, as its main renal applications.O desenvolvimento da Tomografia Computorizada Dual Source (TCDS) (Definition, Siemens Medical Solutions, Erlanger, Germany) permitiu avanços na resolução temporal, com a adição de uma segunda fonte de raios X e de uma fileira de detectores à TCM de 64 cortes. A capacidade de executar exames em Energia Dupla, permite uma maior diferenciação dos tecidos, evidenciando diferenças entre coeficientes de atenuação próximos. Relativamente a aplicações renais, a distinção de cálculos renais e massas tornam-se uma das principais vantagens do uso da tecnologia em energia dupla. Este artigo pretende demonstrar princípios de funcionamento do equipamento em questão, assim como as principais aplicações a nível renal

Relación entre la pérdida de la capacidad masticatoria y el deterioro físico y cognitivo en las personas mayores institucionalizadas

El objetivo de este trabajo fue determinar si la preservación de Unidades Funcionales Masticatorias (UFMs), definidas como los pares de dientes antagonistas que entran en contacto al cerrar la boca, guarda alguna relación con el deterioro funcional y cognitivo de los ancianos. Se diseñó un estudio transversal en el que participaron 502 personas institucionalizadas mayores de 65 años, en las que se registró el número total de UFMs y a las que se aplicaron el test de Barthel y el Mini-Examen Cognoscitivo (MEC). En personas caucásicas institucionalizadas de edad avanzada, el número absoluto de UFMs se relaciona significativamente con los valores del índice de Barthel y MEC, y puede representar un factor predictor de dependencia y de demencia

A Tomografia Computorizada no estudo dos Aneurismas da Aorta Abdominal- do diagnóstico ao pós tratamento

Dissertação submetida à Escola Superior de Saúde do Porto, para cumprimento dos requisitos necessários ao processo de candidatura para atribuição do título de especialista, de acordo com o Decreto-Lei n.º 206/2009 de 31 de agosto publicado em Diário da República, 1ª Série – N.º 168, e com o Regulamento para Atribuição do Título de Especialista no Instituto Politécnico do Porto, publicado em Diário da República, 2ª Série – N.º 200 de 18 de Outubro, através do Despacho n.º 14093/2011.O aneurisma da aorta abdominal (AAA) é uma das patologias vasculares com uma taxa de mortalidade elevada. O aparecimento da Tomografia multicorte permitiu o estudo desta patologia com mais rigor, pois é considerado um método imagiológico não invasivo, com boa resolução temporal, espacial e de contraste, económico e com equipamentos de qualidade existentes na maioria dos centros hospitalares permite a caracterização desta patologia através de reconstruções de imagens bidimensionais e tridimensionais e executar medições com fiabilidade. O objectivo principal deste trabalho foi avaliar o papel da TC no estudo dos aneurismas da aorta abdominal e dar a conhecer ao técnico de radiologia toda a problemática associada ao AAA, de modo a que perante qualquer situação saiba como proceder. Em termos metodológicos este trabalho tem por base uma pesquisa bibliográfica que inclui uma abordagem à tomografia computorizada, ao diagnóstico, tratamento e complicações do aneurisma da aorta seguidamente foi efectuado um estudo retrospectivo e descritivo, em que foram recolhidos e analisados casos de doentes com AAA, que realizaram tratamento endovascular no serviço de Radiologia do CHVNGaia, no período temporal entre 2015 e 2016. Apesar da amostra ser pequena (N=46), conclui-se que a Tomografia Computorizada tem um papel importante no estudo pré tratamento, no controlo após tratamento, nomeadamente na detecção de endoleaks e no seguimento dessas complicações. O estudo também demonstrou que o diagnóstico desta patologia é muitas vezes acidental, no decorrer de uma tomografia computorizada.N/

The effect of carbon nanotubes on viscoelastic behaviour of biomedical grade ultra-high molecular weight polyethylene

Nanocomposites of ultra-high molecular weight polyethylene reinforced with multiwalled carbon nanotubes (UHMWPE/MWCNT) have been prepared with different volume fractions of MWCNTs: 0.2, 0.4, 0.6, 0.8 and 1.0%. DMTA experiments were carried out using a TA Instruments Q800 equipment and the samples were cut from the compressed sheets of polymer and composites. The experiments were conducted on each sample at 12 different frequencies varying from 0.1 Hz to 100 Hz over the temperature range of 22-82 degrees C at an interval of 5 degrees C where the reference temperature was kept at 37 degrees C. It was verified that both horizontal and vertical shifts are necessary to superimpose the dynamic modulus/frequency curves of all cases. The MWCNT did not seem to change the viscoelastic nature of the UHMWPE, i.e. incorporation of up to I wt.% of MWCNTs has negligible influence on the viscoelastic behaviour of the UHMWPE. Hence the same analytical model is applicable for the viscoelastic description of the nanocomposites

Evaluating the efficiency of membrane's refurbishment solutions to perform vertical extensions in old buildings using a multicriteria decision-support model

The initial premise of this research is that the relative efficiency of refurbishment solutions with architectural membranes needs to be measured in order to allow its comparison with conventional solutions, helping decision makers to select the most efficient solutions. The evaluation of this efficiency depends on economic features, but also on functional, technological and environmental ones. This study presents a model to solve this problem, using decision trees, multicriteria decision-making methods (SAW and AHP) and a sensitivity analysis. The selection of the criteria and the assignment of the corresponding weights was attained through an expert group survey for a baseline scenario, aiming maximizing functional performance (such as energy savings) and minimizing employed resources (materials, costs, etc.). The most efficient refurbishment solution among the set of alternatives was reached using the developed model. The methodology was applied to a case study - an old building from the nineteenth century, located in Portugal, which was refurbished with a vertical extension. The result reveals that the proposed model is successful and illustrates the potential of this evaluation methodology to compare and quantify the efficiency of a series of different lightweight constructive solutions. It also underlines the advantages of using lightweight building technologies, especially with architectural membrane materials, in building refurbishments.This research was made possible by the support of the: Portuguese Foundation for Science and Technology (FCT), Portuguese Ministry of Education and Science (MCE) and European Social Fund (ESF) with the reference grant SFRH/BD/104891/2014; the Project UID/AUR/04509/2013 by FCTMEC by national funding and FEDER co-financing under the new PT2020 partnership agreement - Lab2PT, School of Architecture/University of Minho, Portugal; and Project POCI-01-0145-FEDER-007457 - CONSTRUCT - Institute of R&D In Structures and Construction of Faculty of Engineering/University of Porto, Portugal, funded by FEDER funds through COMPETE2020

Peritoneal protein loss, inflammation, and nutrition: refuting myths

Peritoneal protein loss (PPL) has been correlated with mortality, malnutrition and inflammation. More recently overhydration was brought to the equation. This study aims to review classic and recent factors associated with PPL. Prevalent and incident peritoneal dialysis (PD) patients were included. Dialysate and serum IL-6 was obtained during PET. Hydration and nutritional status were assessed by bio-impedance. Linear regression and Cox regression were performed. The 78 included patients presented median values of PPL 4.8 g/24 h, serum IL-6: 5.1 pg/mL, and IL-6 appearance rate 153.5 pg/min. Mean extracellular water excess (EWexc) was 0.88 ± 0.94 L, and lean body mass index (LBMI) 17.3 ± 2.4 kg/m2 . After mean follow-up of 33.9 ± 29.3 months, 12 patients died. Linear univariable analysis showed positive associations between PPL and small solute transport, body composition (LBMI and EWexc), comorbidities and performing CAPD (vs. cycler). PPL correlated positively with dialysate appearance rate of IL-6, but not with serum IL-6. Linear multivariable analysis confirmed positive association between PPL and EWexc (p = 0.012; 95%CI: 4.162–31.854), LBMI (p = 0.008; 95%CI: 1.720–11.219) and performing CAPD (p = 0.023; 95%CI: 4.375–54.190). In survival analysis, no relationship was found between mortality and PPL. Multivariable Cox regression showed Charlson Comorbidity Index (HR: 1.896, 95%CI: 1.235–2.913), overhydration (HR: 10.034, 95%CI: 1.426–70.587) and lower PPL (HR: 0.576, 95%CI: 0.339–0.978) were predictors for mortality. Overhydration, was a strong predictor of PPL, overpowering variables previously reported as determinants of PPL, namely clinical correlates of endothelial dysfunction or local inflammation. PPL were not associated with malnutrition or higher mortality, emphasizing the importance of volume overload control in PD patients.info:eu-repo/semantics/publishedVersio

Seguimento a longo prazo da doença hepática avançada após cura do vírus C com antivíricos de ação direta: dados de uma coorte Portuguesa

Background: Direct-acting antivirals (DAA) have revolutionized hepatitis C treatment, with high sustained virological response (SVR) rates reported, even in historically difficult-to-treat groups. SVR is associated with a decreased risk of hepatocellular carcinoma (HCC), need for transplantation, and overall and liver-related mortality. Data from real-life cohorts on the medium- to long-term outcomes of patients with advanced liver disease and DAA-induced SVR are still missing. Objectives: To report and analyze the long-term outcomes of DAA-induced SVR in a real-life cohort of patients with advanced liver disease. Method: In this retrospective, longitudinal, single-center study, we collected data from patients with chronic hepatitis C infection and advanced liver disease (cirrhosis or advanced fibrosis) that had initiated DAA treatment between February 2015 and January 2017. Results: A total of 237 patients were included. A treatment completion rate of 98.7% and an SVR rate of 97.8% (intention to treat: 96.6%) were found. Of the 229 patients with SVR, 67.2% were cirrhotic (64.2% Child-Pugh class A; 3.1% Child-Pugh class B) and 32.8% had stage F3 fibrosis, with an average follow-up of 28 months. The overall mortality rate was 19/1,000 person-years and the liver-related mortality rate was 9.5/1,000 person-years. The hepatic decompensation incidence rate was 25/1,000 person-years and the HCC incidence rate was 11.6/1,000 person-years. There was a sustained increase in serum platelet values during up to 2 years of follow-up. A history of pretreatment decompensation and baseline platelet and albumin values were significantly associated with the occurrence of adverse liver events after the end of treatment. Conclusions: A DAA-induced SVR remains durable and is associated with an excellent clinical prognosis in patients with compensated advanced liver disease and with improvement or disease stabilization in decompensated patients. SVR is associated with a low risk of - yet does not prevent - HCC occurrence or disease progression, especially in the presence of other causes of liver injury. It is recommended that these patients be kept under surveillance.info:eu-repo/semantics/publishedVersio

The Current Portrayal of Non-Variceal Upper Gastrointestinal Bleeding in a Portuguese Tertiary Center

Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important healthcare problem whose epidemiology and outcomes have been changing throughout the years. The main goal of this study was to characterize the current demographics, etiologies, and risk factors of NVUGIB. Methods: Analysis of clinical, endoscopic, and outcome data from patients who were admitted for NVUGIB between January 2016 and January 2019 in an emergency department of a tertiary hospital center. Results: A total of 522 patients were included, with a median age of 71 years, mainly men, with multiple comorbidities. Most patients were directly admitted, while the others were transferred from other hospitals. Peptic ulcer disease was the most common cause of NVUGIB and it was followed by tumor bleeding. Esophagogastroduodenoscopy was performed within <12 h after hospital admission in 51.9%. In-hospital rebleeding occurred in 6.9% and overall mortality was 4.2%. Transferred patients had superior Glasgow-Blatchford score (GBS), required more blood transfusion, endoscopic and surgical interventions, and presented higher rebleeding rate, with similar mortality. Complete Rockall score (CRS) and GBS were predictors of endoscopic therapy. Surgery need was only related to CRS. Patients who rebled had superior pre-endoscopic Rockall score (RS), CRS, and GBS. Mortality was increased in patients with higher RS and CRS. Discussion/Conclusion: Ageing and increasing comorbidities have not been related to worse outcomes in NVUGIB. These findings seem to be the consequence of the correct use of both diagnostic and therapeutic tools in an organized and widely accessible healthcare system