Post-Tracheal Extubation Pulmonary Oedema. Case Report

O edema agudo do pulmão pós-extubação traqueal é um acontecimento raro (≈ 0,1%)1. A etiologia é multifactorial, sendo a obstrução da via aérea superior o factor desencadeante principal. O esforço inspiratório contra a glote encerrada causa pressões intra torácicas muito negativas, que se transmitem ao interstício pulmonar, condicionando uma transudação de fluidos a partir dos vasos capilares pulmonares1-5. Relatamos um caso de edema agudo do pulmão pós-extubação num doente de quinze anos, operado no serviço de urgência por amputação traumática da perna esquerda. Revemos a fisiopatologia, o padrão radiológico, potenciais factores de risco e medidas preventivas desta complicação respiratória pós-anestésica

Clinical and Radiographic Findings in Swyer-James MacLeod Syndrome — A Case Report

Descreve-se um caso de Sindroma de Swyer-James MacLeod, após uma introdução em que se definem as principais características desta entidade, com particular relevo para os aspectos radiográficos, se expõem as teorias etiopatogénicas e o quadro clínico habitual. Na discussão do caso clínico realça-se o papel da infecção pelo vírus do sarampo e expõem-se as razões da metodologia utilizada no diagnóstico

Faster k-Medoids Clustering: Improving the PAM, CLARA, and CLARANS Algorithms

Clustering non-Euclidean data is difficult, and one of the most used algorithms besides hierarchical clustering is the popular algorithm Partitioning Around Medoids (PAM), also simply referred to as k-medoids. In Euclidean geometry the mean-as used in k-means-is a good estimator for the cluster center, but this does not hold for arbitrary dissimilarities. PAM uses the medoid instead, the object with the smallest dissimilarity to all others in the cluster. This notion of centrality can be used with any (dis-)similarity, and thus is of high relevance to many domains such as biology that require the use of Jaccard, Gower, or more complex distances. A key issue with PAM is its high run time cost. We propose modifications to the PAM algorithm to achieve an O(k)-fold speedup in the second SWAP phase of the algorithm, but will still find the same results as the original PAM algorithm. If we slightly relax the choice of swaps performed (at comparable quality), we can further accelerate the algorithm by performing up to k swaps in each iteration. With the substantially faster SWAP, we can now also explore alternative strategies for choosing the initial medoids. We also show how the CLARA and CLARANS algorithms benefit from these modifications. It can easily be combined with earlier approaches to use PAM and CLARA on big data (some of which use PAM as a subroutine, hence can immediately benefit from these improvements), where the performance with high k becomes increasingly important. In experiments on real data with k=100, we observed a 200-fold speedup compared to the original PAM SWAP algorithm, making PAM applicable to larger data sets as long as we can afford to compute a distance matrix, and in particular to higher k (at k=2, the new SWAP was only 1.5 times faster, as the speedup is expected to increase with k)

Reinforcement and Homework Control for Children with ASD using a Mobile Application for Apple Watch

Cursos e Congresos, C-155[Abstract] The article shows the design and development of a pair of mobile applications for Apple Watch and iPhone devices to reinforce and control tasks for children with autism disorders. This work takes advantage of the possibilities of smartwatches, such as internet connectivity, access to biometric sensors and ease of communication with users, to improve their autonomy in carrying out everyday routines. The application has been designed taking into account the needs and characteristics of this group, collaborating with two non-profit organisations in the area of AIXunta de Galicia; ED431C 2020/15This work has been supported by grant ED431C 2020/15 funded by Xunta de Galicia and ERDF Galicia 2014-2020; by grant PID2019-104958RB-C42 (ADELE) funded by MCIN/AEI/10.13039/501100011033; and by project TED2021-130240B-I00 (IVRY) funded by MCIN/AEI/10.13039/501100011033 and by the European Union NextGenerationEU/PRT

Piezoelectric actuators for bone mechanical stimulation: exploring the concept.

Arthroplasty is liable to cause intense changes on strain levels and distribution in the boné surrounding the implant, namely stress shielding. Several solutions have been proposed for this, namely design variations and development of controlled-stiffness implants. A new approach to this problem, with potential application to other orthopaedic problems and other medical fields, would be the development of smart implants integrating systems for bone mechanical stimulation. Ideally, the implant should presente sensing capability and the ability to maintain physiological levels of strain at the implant interface. Piezoelectric materials’ huge potential as a mean to produce direct mechanical stimulation lies on the possibility of producing stimuli at a high range of frequencies and in multiple combinations. The present in vitro and preliminary in vivo studies were a first step towards the validation of the concept

Laser Monotherapy in Plantar Fasciitis

Introdução: A fasceíte plantar (FP) constitui a causa mais frequente de dor no retropé. Está recomendada uma prova terapêutica inicial conservadora. Objetivos: Caraterizar fatores demográficos e sintomáticos, terapêutica prévia e resultados de monoterapia com laser. Material e Métodos: Estudo observacional retrospetivo (12 meses). O tratamento aplicado foi laser infravermelho (AsGa 904nm; densidade de energia 20J/cm2; potência de pico 200mW). Fez-se análise estatística descritiva e comparativa (nível de significância de 0,05). Resultados: Seguiram-se 32 doentes com FP, com idade média de 54,28 anos (24–86; DP 13,95), 66% mulheres, Índice de Massa Corporal (IMC) médio de 30,18Kg/m2 (17,91-41,13; DP 5,19), 75% unilaterais, tempo médio de evolução de 6,28 meses (0,2-24; DP 6,82), 21 tinham feito previamente farmacoterapia e 12 outros tratamentos de MFR. O nível de dor inicial (END) médio foi 7,31 (5-10; DP 1,38). Dos 26 doentes tratados (6 perdas), 24 (92,3%) reportaram melhoria. O número médio de sessões foi 28,5 (11– 60; DP 14,01). O nível médio de dor final foi 0,75 (0-5; DP 2,37), com melhoria média de 89,7% (28,6%-100%; DP 0,16) do nível de dor. A intensidade de dor inicial foi maior em doentes com IMC superior (p=0,002). Não se encontraram outras relações estatisticamente significativas. Conclusões: A FP caraterizou-se por um nível de dor significativo (moderado a grave). A obesidade pareceu ser um fator de risco. A taxa de melhoria com o tratamento com laser foi muito satisfatória. A terapia com laser de baixa intensidade IV constitui uma boa opção terapêutica, a justificar avaliação suplementar por ensaios prospetivos controlados e randomizados

Reprodutibilidade e Validade da Versão Portuguesa da Escala de Fragilidade de Edmonton em Doentes de Cirurgia Cardíaca

Introduction: Frailty is a multidimensional syndrome characterized by the loss of functional reserve, associated with higher mortality and less functional survival in cardiac surgery patients. The Edmonton Frail Scale (EFS) is a comprehensive tool devised for brief frailty detection. To the best of our knowledge, there are no culturally adapted and validated frailty screening tools that enable the identification of vulnerability domains suited for use in the preoperative setting in Portugal. This was the motivation for this study. Objectives: To assess the validity and reproducibility of the Portuguese version of the EFS. Methods: Prospective observational study, in a sample of elective cardiac surgery patients. The Edmonton Frail Scale (EFS) translation and backtranslation were performed. Demographic and clinical data were collected, and the translated EFS translated, Geriatric Depression Scale, and Mini Mental State Examination Portuguese versions, Katz and Clinical Frailty Scales were administered. To assess validity Mann-Whitney test, Spearman's correlation coefficient, marginal homogeneity test and Kappa coefficient were employed. Reproducibility was assessed estimating kappa coefficient for the frailty diagnosis and the 11 EFS items. Intra-class correlation coefficients and the corresponding 95% confidence interval were estimated using linear mixed effects model. Results: The EFS Portuguese version revealed construct validity for frailty identification, as well as criterion validity for cognition and mood domains. Reproducibility was demonstrated, with k=0.62 (95% confidence interval (CI) 0.42-0.82) and intraclass correlation (ICC)=0.94 (95% CI 0.89-0.97) in inter-observer test and k=0.48 (95% CI 0.26-0.70) and ICC=0.85 (95% CI 0.72-0.92) in intra-observer test. Conclusions: The EFS Portuguese version is valid and reproducible for use, suiting pre-operative frailty screening in a cardiac surgery setting.Introdução: A fragilidade é uma síndrome multidimensional caracterizada pela perda de reserva funcional, associada a maior mortalidade e menor sobrevivência funcional após cirurgia cardíaca. A Escala de Fragilidade de Edmonton (EFS) é uma ferramenta abrangente de deteção de fragilidade. Não existe ainda em Portugal uma ferramenta de rastreio culturalmente adaptada e validada que permita a identificação de domínios específicos de vulnerabilidade para utilização no pré-operatório. Objetivos: Avaliar a validade e reprodutibilidade da versão portuguesa da EFS. Métodos: Estudo prospetivo observacional, realizado numa amostra de doentes propostos para cirurgia cardíaca. A EFS foi traduzida e retrotraduzida. Colheram-se dados demográficos e clínicos, aplicaram-se as versões traduzidas da EFS, Escala de Depressão Geriátrica e MMSE, as escalas de Katz e Clinical Frailty Scale. Validade avaliada utilizando o teste de Mann-Whitney, o coeficiente de correlação de Spearman, o teste de homogeneidade marginal e o coeficiente Kappa. Reprodutibilidade avaliada pelo cálculo do coeficiente kappa para o diagnóstico de fragilidade e para os 11 itens da escala. Coeficientes de correlação intraclasse e correspondentes intervalos de confiança a 95% estimados usando um modelo linear de efeitos mistos. Resultados: A versão portuguesa da EFS demonstrou validade de constructo, assim como validade de critério nos domínios de cognição e humor. É reprodutível, com k=0,62 (95% IC 0,42-0,82) e CCI=0,94 (95% IC 0,89-0,97) no teste interobservador e k=0,48 (95% IC 0,26-0,70) e CCI=0,85 (95% IC 0,72-0,92) no teste intraobservador. Conclusões: A versão portuguesa da EFS é adequada para rastreio pré-operatório de fragilidade em cirurgia cardíaca.info:eu-repo/semantics/publishedVersio

Association between homicide rates and suicide rates: a countrywide longitudinal analysis of 5507 Brazilian municipalities

Objective: To estimate the association between homicide and suicide rates in Brazilian municipalities over a period of 7 years. / Design: We conducted a longitudinal ecological study using annual mortality data from 5507 Brazilian municipalities between 2008 and 2014. Multivariable negative binomial regression models were used to examine the relationship between homicide and suicide rates. Robustness of results was explored using sensitivity analyses to examine the influence of data quality, population size, age and sex on the relationship between homicide and suicide rates. / Setting: A nationwide study of municipality-level data. / Participants: Mortality data and corresponding population estimates for municipal populations aged 10 years and older. / Primary and secondary outcome measures: Age-standardised suicide rates per 100 000. / Results: Municipal suicide rates were positively associated with municipal homicide rates; after adjusting for socioeconomic and demographic factors, a doubling of the homicide rate was associated with 22% increase in suicide rate (rate ratio=1.22, 95% CI: 1.13 to 1.33). A dose–response effect was observed with 4% increase in suicide rates at the third quintile, 9% at the fourth quintile and 12% at the highest quintile of homicide rates compared with the lowest quintile. The observed effect estimates were robust to sensitivity analyses. / Conclusions: Municipalities with higher homicide rates have higher suicide rates and the relationship between homicide and suicide rates in Brazil exists independently of many sociodemographic and socioeconomic factors. Our results are in line with the hypothesis that changes in homicide rates lead to changes in suicide rates, although a causal association cannot be established from this study. Suicide and homicide rates have increased in Brazil despite increased community mental health support and incarceration, respectively; therefore, new avenues for intervention are needed. The identification of a positive relationship between homicide and suicide rates suggests that population-based interventions to reduce homicide rates may also reduce suicide rates in Brazil

Trends in method-specific suicide in Brazil from 2000 to 2017

Purpose: Understanding long-term patterns of suicide methods can inform public health policy and prevention strategies. In Brazil, firearm-related policies may be one salient target for suicide prevention. This study describes trends in method-specific suicide at the national and state-levels in Brazil, with a particular focus on firearm-related suicides. / Methods: Brazilian mortality data for suicide and undetermined intent among people aged 10 years and older between 2000 and 2017 were obtained from the National Mortality Information System. We examined national and state-level trends in age-standardised suicide rates for hanging, self-poisoning, firearms, jumping from a high place, other, and unspecified methods. We also compared total rates of mortality from suicide and undetermined intent over the period. Applying Joinpoint regression, we tested changes in trends of firearm-specific suicide rates. / Results: The total suicide rate increased between 2000 and 2017. Rates of hanging, self-poisoning by drugs or alcohol and jumping from a high place showed the largest increases, while firearm-specific suicide rates decreased over the study period. Trends in methods of suicide varied by sex and state. / Conclusion: It is of public health concern that suicide rates in Brazil have risen this millennium. Restricting access to firearms might be an effective approach for reducing firearm-specific suicides, especially in states where firearm availability remains particularly high. Treatment and management of substance misuse may also be an important target for suicide prevention policies. More work is needed to understand the causes of rising suicide rates in Brazil and to improve the mental health of the population