Road traffic reduces pedestrian accessibility – Quantifying the size and distribution of barrier effects in an African city

BACKGROUND AND OBJECTIVE: Motorised traffic is growing rapidly in many African cities, creating barriers to the movement of pedestrians. This paper analyses the barrier effect of roads in Praia, the capital of Cabo Verde. We measured the barrier effect to potential trips to homes of other people and to food shops and analysed the distribution of the effect across areas and social groups. The paper contributes to the literature by: 1) quantifying the barrier effect of roads for the first time in an African city; 2) mapping the effect at the city level, and 3) developing indicators that account for land use (i.e. what is on the other side of the road). METHODS: We used spatial analysis to estimate, for each building in the city, two indicators: the proportions of the areas of other buildings and of food shops within 600m that are located across main roads. We then analysed the distribution of those indicators using descriptive statistics, cumulative frequencies, bivariate associations, and regression models. RESULTS: In some areas, roads are estimated to curtail more than 70% of the walking accessibility potential of residents. The effect is higher in older informal settlements than in formally planned areas or newer informal settlements, and it disproportionately affects individuals aged 65+. The effect is lower for households with very high and very low socio-economic status than for those with high, medium, or low status. The indicators are robust to changes in the assumptions (e.g. type of roads included, maximum walking distance, attractiveness of destinations) and provide extra information, compared with simpler indicators (e.g. distance to roads or length of roads within a certain distance)

Guillain-Barré syndrome: advances and future perspectives

The first case of Guillain-Barré syndrome was described in 1916. Since then, knowledge about the pathophysiology and immunogenesis of this acquired inflammatory polyradiculoneuropathy has been growing steadily, especially after the advent of nerve conduction studies and the discovery of pathogenic autoantibodies. In the present study, we conducted a review of the main information available in the literature to date about the syndrome, including its diagnosis and management

Indifferentiated osteoclastic-type giant cell carcinoma

Initially described 40 years ago (Rosai), the undifferentiated osteoclastic-type giant cell carcinoma (IOGCC) is a variant of ductal adenocarcinoma and accounts for less than 1% of exocrine pancreatic tumors. Its extreme rarity, with consequent existence of few reports and clinical experience, leads to the arousal of doubts with regard to its histogenesis, types of approach and therapeutical attitudes. It is important to note that in Portugal no similar case is registered in medical literature. A 61 year old patient admitted to the Internal Medicine Ward 3 at Coimbra University Hospital presents with a volumous intra-abdominal mass in the left hypochondrium and microcytic anemia. During the investigation, a pancreatic neoplasm was identified, and the patient was submitted to surgical resection, the anatomo-pathological study of the tumor having revealed IOGCC. The particularities of the case, current available therapeutical options and its evolution are discussed, as well as a revision of the existing literature

Spatial mismatch and livelihoods in a fast-growing lower middle-income city: Praia, Cape Verde

This paper evaluates public transport accessibility to formal and informal employment opportunities in a city in a middle-income country: Praia, the capital of Cape Verde. Due to geographic constraints and rapid growth of population, income, road network, and car ownership, employment is dispersed throughout the city. Public transport is limited in terms of geographic coverage and connectivity. Accessibility is evaluated in terms of the number of bus trips required to access work places and the walking times to bus stops. The results show that deprived areas are at a disadvantage in the access to formal employment opportunities when comparing with more affluent areas. Some areas also have limited accessibility to spaces for informal employment, when considering public transport options and competition for these spaces

Disfunção tiróidea e amiodarona

Although most patients remain clinically euthyroid, some develop amiodarone-induced hyperthyroidism (HPEAI) or hypothyroidism (HPOAI). The authors present a retrospective analysis of ten patients with amiodarone-induced thyroid dysfunction. Six patients were female and mean amiodarone intake was 17.7 months. HPOIA was more common (six patients). From all the patients with HPEAI, two had type 2, one had type 1, and one had type 3 hyperthyroidism. Symptoms suggestive of thyroid dysfunction occurred in five patients, most of them with HPOAI. In HPEAI, the most frequent symptom was exacerbation of arrhythmia (three patients). Discontinuation of amiodarone and treatment with levothyroxine was chosen in 83.3% of the HPOAI cases, while thyonamide treatment with corticosteroids and without amiodarone was the option in 75% of the HPEAI cases. There were three deaths, all in patients with HPEAI. HPEAI is potentially fatal. The clinical picture may be vague, so the thyroid monitoring is mandatory

Paraquat Intoxication – experience of an Internal Medicine ward for 18 years

Introduction: Paraquat is a contact herbicide commercially available since 1962. Paraquat intoxication (PI) is usually voluntary and highly lethal, since there is no effective antidote. Toxicity occurs through cyclic redox reactions, damaging mainly the kidneys and lungs. Aim, material and methods: featuring the clinical presentation, management and outcome of patients with PI over an 18 years period (from the 01st January 1993 to the 31st December 2010) through the retrospective analysis of clinical files and comparing the survivors and the deceased. Results: Thirty-one cases of Paraquat intoxication were included, with a male: female ratio 1:1. Age range from 13 to 80 years, mean age 42.4years (±18.7).All intoxications were voluntary and by oral route. There was statistical difference in the amount ingested (22.1 mL vs. 72.7 mL, p<0.0005). A non-significant trend to a longer delay until getting medical attention in the deceased group (1.6 h vs. 3.2 h, p=0.091). Statistical significance was found between mortality and leukocytosis, hypocapnea, hypoxemia, LDH, alkaline phosphatase and AST. There was no difference between groups according to treatment options, although hemocarboperfusion was used more often in the deceased group (53.9% vs. 66.7%, p=0.471) and corticosteroids in the survivor group (61.5% vs. 44.4%, p=0.350). Mortality rate was 58.1% (66.7% in the first 72 hours), due to respiratory insufficiency and multiple organ failure. Variable levels of pulmonary fibrosis occurred in 38.5% of the survivors. Discussion & Conclusion: Paraquat intoxication has a poor prognosis with limited efficiency of treatment approaches. The relation between Paraquat in the urine and the time elapsed after ingestion is the main determinant factor in the prognosis. In this study the presence of dyspnea, hypocapnea and hypoxemia was linked to a bad prognosis. There was no statistical difference between the available treatment options