947 research outputs found
Subaortic Stenosis Following Anatomic Correction for Transposition of the Great Arteries
Os autores descrevem o caso clínico de uma
criança do sexo masculino, com 12 anos de
idade, com diagnóstico pós-natal de
transposição das grandes artérias com
comunicação interventricular, submetida a
switch arterial e encerramento da
comunicação interventricular. Durante o
seguimento pós-operatório detectou-se um
obstáculo entre o ventrículo esquerdo e a
aorta ascendente que foi, inicialmente, de
grau ligeiro. No último ano começou a referir
sintomatologia (cansaço para esforços
moderados). Na avaliação efectuada
detectou-se uma estenose aórtica subvalvular
grave, tendo o doente sido submetido a
tratamento cirúrgico, com bom resultado.
A estenose aórtica subvalvular é uma
complicação rara, que tem sido descrita em
estudos de follow-up de switch arterial,
sobretudo nas situações em que o defeito
primário é a transposição das grandes
artérias com comunicação interventricular
Prevalência e crioconservação de Escherichia coli β-glucoronidase positiva em produtos de origem alimentar
Comunicação oral da qual só está disponível o resumo.Prevalência e crioconservação de Escherichia coli β-glucoronidase positiva em produtos de origem alimentar
Effectiveness of unsupervised physical activity interventions in people with COPD: a systematic review and meta-analysis
No abstract available.publishe
Unsupervised physical activity interventions for people with COPD: a systematic review and meta-analysis
Introduction and objectives
Unsupervised PA interventions might have a role in the management of chronic obstructive pulmonary disease (COPD) but their effectiveness is largely unknown. Thus, we aimed to identify and synthesise data on the effects of unsupervised PA interventions in people with COPD.
Material and methods
Databases were systematically searched in April 2020, with weekly updates until September 2021. Randomised controlled trials and quasi-experimental studies comparing unsupervised PA with usual care, were included. Primary outcomes were dyspnoea, exercise capacity and physical activity. The effect direction plot was performed to synthesise results. Meta-analysis with forest plots were conducted for the Chronic Respiratory Disease questionnaire – dyspnoea domain (CRQ-D), 6-minute walk distance (6MWD) and incremental shuttle walk distance (ISWD).
Results
Eleven studies with 900 participants with COPD (68±10 years; 58.8% male, FEV1 63.7±15.8% predicted) were included. All interventions were conducted at home, most with daily sessions, for 8-12 weeks. Walking was the most common component. The effect direction plot showed that unsupervised PA interventions improved emotional function, fatigue, health-related quality of life, muscle strength and symptoms of anxiety and depression. Meta-analysis showed statistical, but not clinical, significant improvements in dyspnoea (CRQ-D, MD=0.12, 95% CI 0.09-0.15) and exercise capacity, measured with 6MWD (MD=13.70, 95% CI 3.58-23.83). Statistical and clinical significant improvements were observed in exercise capacity, measured with ISWD (MD=58.59, 95% CI 5.79-111.39). None to minor adverse events and a high adherence rate were found.
Conclusions
Unsupervised PA interventions benefits dyspnoea and exercise capacity of people with COPD, are safe and present a high adherence rate. Unsupervised PA interventions should be considered for people with COPD who cannot or do not want to engage in supervised PA interventions or as a maintenance strategy of PA levels.publishe
A lean case study in an oncological hospital: implementation of a telephone triage system in the emergency service
Abstract: Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed ‘remote’ triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients
Zika, chikungunya and dengue: the causes and threats of new and re-emerging arboviral diseases.
The recent emergence and re-emergence of viral infections transmitted by vectors-Zika, chikungunya, dengue, Japanese encephalitis, West Nile, yellow fever and others-is a cause for international concern. Using as examples Zika, chikungunya and dengue, we summarise current knowledge on characteristics of the viruses and their transmission, clinical features, laboratory diagnosis, burden, history, possible causes of the spread and the expectation for future epidemics. Arboviruses are transmitted by mosquitoes, are of difficult diagnosis, can have surprising clinical complications and cause severe burden. The current situation is complex, because there is no vaccine for Zika and chikungunya and no specific treatment for the three arboviruses. Vector control is the only comprehensive solution available now and this remains a challenge because up to now this has not been very effective. Until we develop new technologies of control mosquito populations, the globalised and urbanised world we live in will remain vulnerable to the threat of successive arbovirus epidemics
Permanent Junctional Reciprocating Tachycardia: an Incessant Tachycardia in Children
A taquicardia juncional recíproca permanente
é uma forma de taquicardia supraventricular
de reentrada pouco comum, embora constitua a
causa mais frequente de taquicardia incessante em crianças. O seu carácter permanente causa disfunção ventricular esquerda e miocardiopatia dilatada e é de difícil controlo terapêutico.
Objectivo: Rever as características clínicas
mais significativas desta arritmia, a sua
evolução e as opções terapêuticas actuais.
Métodos: estudo retrospectivo, analisando a
forma de apresentação e evolução, com
particular relevo para a resposta à terapêutica farmacológica e alternativas terapêuticas.
Doentes: Grupo de 5 doentes com o diagnóstico
de taquicardia juncional recíproca permanente.
Resultados: As crianças estudadas tinham
idades compreendidas entre os 14 dias e os 12
anos. Três encontravam-se assintomáticas. O
primeiro ecocardiograma demonstrou dilatação
do ventrículo esquerdo e diminuição da fracção de encurtamento em uma das crianças. A terapêutica farmacológica foi inicialmente
eficaz em todos os casos. Ao longo do
seguimento (0,2-4,5 anos) a arritmia tornou-se refractária em um dos casos, pelo que se
procedeu a ablação da via anómala por
radiofrequência.
Conclusões: A taquicardia juncional recíproca
permanente tem diversas formas de
apresentação. A terapêutica farmacológica é
recomendada, mas tem carácter transitório. A
ablação por radiofrequência é o tratamento
definitivo, estando condicionada pela idade dos doentes
Investigar e inovar na educação em ciências para um futuro sustentável
No pico de uma real situação de emergência planetária, a educação torna-se a melhor
aliada de uma luta global com vista a um desenvolvimento sustentável. Para
concretizar a Década da Educação para um Futuro Sustentável, a investigação em
educação em ciências e a correspondente inovação na formação de professores e no
ensino, apresentam-se entre os contributos mais fortes, amplos e eficazes. Parte do
nosso contributo, que se apresenta neste artigo, tem passado pelo desenvolvimento
de alguns estudos situados no quadro teórico que sustenta a educação CTS e assentes
em temáticas centrais para a educação para a sustentabilidade ambiental: os
transportes e a mobilidade, o uso da água, a fome no mundo, a preservação da
biodiversidade. A aposta tem-se dirigido para o ensino nos primeiros anos através do
desenho de propostas didácticas validadas por especialistas e em sala de aula e
utilizadas quer no ensino quer como ferramentas de formação inicial e contínua de
professores
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