Proposta de modelo de avaliação do estado de conservação de equipamentos escolares

Dissertação para obtenção de grau de Mestre em Engenharia Civil na Área de Especialização de EdificaçõesO estado de degradação de edifícios em Portugal tem aumentado drasticamente, devido à falta de manutenção. A manutenção de estabelecimentos escolares em Portugal, é ainda mais escassa, sendo inexistente uma metodologia que avalie o estado de conservação de estabelecimentos escolares. Em países como o Reino Unido e Austrália, são utilizadas metodologias avançadas, que avaliam o estado de conservação de estabelecimentos escolares, inserindo-se como uma das fases essenciais para se proceder à manutenção e reparação dos estabelecimentos. Nesta dissertação apresenta-se uma proposta de um Método de Avaliação do Estado de Conservação de Estabelecimentos Escolares, tendo por base o Método de Avaliação do Estado de Conservação de edifícios (MAEC) desenvolvido no LNEC. A proposta desenvolvida, permite avaliar o estado de conservação de estabelecimentos escolares do ensino pré-escolar e 1º Ciclo. O método proposto foi testado numa amostra de dois estabelecimentos escolares: – Escola EB1 Teixeira de Pascoais e Escola EB1 Telheiras nº 1 – permitindo avaliar os elementos funcionais através do método desenvolvido, obtendo o estado de conservação de cada estabelecimento escolar mencionado. O método criado demonstrou ser eficaz e bem adaptado à realidade dos estabelecimentos escolares do 1º Ciclo, sendo um método rápido de aplicar, identificando-se rapidamente elementos funcionais em mau estado de conservação e a necessitar de reparações.Abstract: The state of decay of Portuguese buildings has been increasing dramatically due to lack of maintenance since their construction. The maintenance of Portuguese school buildings is stillscarce and there are not standardized methodologies to assess the condition of schoolbuildings. In countries like the United Kingdom and Australia advanced methodologies to assess the condition of school buildings are used which is an important phase in the implementation of procedures for maintenance and repair of buildings. This dissertation presents a method for schools building condition assessment based on the Portuguese method for buildings condition assessment (MAEC) developed at the Laboratório Nacional de Engenharia Civil. The proposed method allows the condition assessment of elementary school buildings. The proposed method was tested in a sample of two elementary school buildings: EB1 Teixeira de Pascoais school and EB1 number 1 Telheiras elementary school. The fieldwork allowed the assessment of different functional elements of the schools with the developed method and the global building condition assessment. The established method proved to be effective and well adapted to elementary schoolscharacteristics. This method is simples to apply, allowing the identification of the functional elements in poor condition and requiring repair works

Mais do que uma causa rara de hipertensão arterial pulmonar no idoso

© 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).An 80-year-old woman with a history of systemic hypertension and dual-chamber pacemaker implantation for sick sinus syndrome presented to the hospital with worsening dyspnea and fatigue for several months. The chest X-ray (Figure 1A) showed a markedly enlarged cardiac silhouette along with a tubular opacity (dotted lines) paralleling the right heart border. Echocardiographic examination depicted dilated right heart chambers, right ventricular dysfunction and a high probability of pulmonary hypertension.info:eu-repo/semantics/publishedVersio

Aortic valve endocarditis by a rare infectious agent in a patient with a rare congenital mitral valve abnormality

© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] description: A 66-year-old woman with a past medical history of high blood pressure, Type 2 diabetes mellitus and no clinical evidence of immunocompromise, presented to the emergency room with fever and acute pulmonary oedema. The patient had presented low-grade fever and anorexia in the previous 3 weeks.info:eu-repo/semantics/publishedVersio

The national students survey applied to Portuguese Biomedical Laboratory Science Students

Assessment of students’ experience and perceptions of the academic quality of particular programmes, course units and teachers are currently widespread and encouraged. Internationally, student feedback is highly valued by educational institutions, and it is used to improve teaching effectiveness and overall educational quality, as well as to inform prospective students and other stakeholders. The few measures of students’ perceptions and satisfaction adopted for Portuguese students have some limitations and lack adequate replication.info:eu-repo/semantics/publishedVersio

Unexpected mass in the left atrium

Todo o conteúdo do periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons.info:eu-repo/semantics/publishedVersio

The role of cardiovascular magnetic resonance in takotsubo syndrome

© 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Takotsubo syndrome (TS) is a transient form of left ventricular dysfunction associated with a distinctive contraction pattern in the absence of significant coronary artery disease triggered by stressful events. Several aspects of its clinical profile have been described but it still remains difficult to quickly establish the diagnosis at admission.Cardiovascular magnetic resonance (CMR) has achieved great improvements in the last years, which in turn has made this imaging technology more attractive in the diagnosis and evaluation of TS. With its superior tissue resolution and dynamic imaging capabilities, CMR is currently the most useful imaging technique in this setting.In this review, we propose to comprehensively define the role of CMR in the evaluation of patients with TS and to summarize a set of criteria suitable for diagnostic decision making in this clinical setting.info:eu-repo/semantics/publishedVersio

Direct oral anticoagulants versus vitamin K antagonists in patients with antiphospholipid syndrome: systematic review and meta-analysis

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.Background: Despite vitamin K antagonists (VKA) being the gold standard in the prevention of thromboembolic events in antiphospholipid syndrome (APS), non-vitamin K antagonists oral anticoagulants/direct oral anticoagulants (DOACs) have been used off-label. Objective: We aimed to perform a systematic review comparing DOACs to VKA regarding prevention of thromboembolic events, occurrence of bleeding events and mortality in patients with APS. Methods: An electronic database search was performed through MEDLINE, CENTRAL and Web of Science. After data extraction, we pooled the results using risk ratio (RR) and 95% CI. Heterogeneity was assessed using the I². The outcomes considered were all thromboembolic events as primary, and major bleeding, all bleeding events and mortality as secondary. Evidence confidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Results: We included 7 studies and a total of 835 patients for analyses. Thromboembolic events were significantly increased in DOACs arm, compared with VKA-RR 1.69, 95% CI 1.09 to 2.62, I²-24%, n=719, 6 studies. In studies using exclusively rivaroxaban, which was the most representative drug in all included studies, the thromboembolic risk was increased threefold (RR 3.36, 95% CI 1.53 to 7.37). The risks of major bleeding, all bleeding events and mortality were not significantly different from control arm. The grade of certainty of our results is very low. Conclusions: Current evidence suggests DOACs use, particularly rivaroxaban, among patients with APS, is less effective than VKA since it is associated with 69% increased risk of thromboembolic events.info:eu-repo/semantics/publishedVersio

Comparison of 5 acute pulmonary embolism mortality risk scores in patients with COVID-19

© The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Objective: Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. We aimed to explore the short-term outcomes among patients with acute PE and COVID-19 and to further determine and compare the performance of the different prognostic scores (PESI, sPESI, BOVA, FAST and ESC scores) for risk-stratification in this scenario. Methods: Retrospective single-centre study of 85 patients with SARS-CoV-2 infection and PE admitted to the Emergency Department (ED). The diagnostic accuracy of each above-mentioned prognostic score was calculated post hoc, and their discriminative power was evaluated through an AUC curve. Results: Among the 85 patients, all-cause death occurred within 7 days for 6 patients (7.1%) and within 30 days for 14 patients (16.5%). Despite being older and having a higher percentage of altered mental status on presentation, non-survivors patients did not differ from survivors regarding comorbidities, traditional risk factors for venous thromboembolism and signs and symptoms at the ED presentation.Each risk stratification tool had modest discriminative power for 7-day mortality (AUC range, 0.601-0.730) with slightly lower discrimination for 30-day mortality (AUC range, 0.543-0.638). The pair-wise comparison of ROC curves showed that PESI had better predictive value for short-term mortality than ESC score (z test = 3.92, p = 0.001) and sPESI (z test = 2.43, p = 0.015); there is no significant difference between PESI and BOVA score (z test = 1.05, p = 0.295) and FAST score (z test = 0.986, p = 0.324). Conclusion: The most common risk-stratification tools for PE had modest discriminative power to predict short-term mortality in patients with acute PE and COVID-19.info:eu-repo/semantics/publishedVersio

Left atrial abnormal mechanics by speckle tracking as an early subclinical manifestation in patients with systemic sclerosis

© The European Society of Cardiology 2018. All rights reserved.Introduction: Heart involvement in systemic sclerosis (SSc) affects the prognosis of the disease when clinically evident. SSc may be associated with myocardial microvascular obstruction and micronecrosis is a presumible determinant of ventricular dysfunction, heart failure and sudden death. The aim of this study was to assess whether there were early changes of left atrial (LA) deformation by speckle tracking in patients with normal ejection fraction.info:eu-repo/semantics/publishedVersio

Hipertensão pulmonar tromboembólica crónica: experiência inicial de doentes submetidos a tromboendarterectomia pulmonar

© 2021 Published by Elsevier España, S.L.U. on behalf of Sociedade Portuguesa de Cardiologia. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Introduction and objectives: Pulmonary endarterectomy (PEA) is a potentially curative procedure in patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study reports the initial experience of a Portuguese PH center with patients undergoing PEA at an international surgical reference center. Methods: Prospective observational study of consecutive CTEPH patients followed at a national PH center, who underwent PEA at an international surgical reference center between October 2015 and March 2019. Clinical, functional, laboratory, imaging and hemodynamic parameters were obtained in the 12 months preceding the surgery and repeated between four and six months after PEA. Results: 27 consecutive patients (59% female) with a median age of 60 (49-71) years underwent PEA. During a median follow-up of 34 (21-48) months, there was an improvement in functional class in all patients, with only one cardiac death. From a hemodynamic perspective, there was a reduction in mean pulmonary artery pressure from 48 (42-59) mmHg to 26 (22-38) mmHg, an increase in cardiac output from 3.3 (2.9-4.0) L/min to 4.9 (4.2-5.5) L/min and a reduction in pulmonary vascular resistance from 12.1 (7.2-15.5) uW to 3.5 (2.6-5,2) uW. During the follow-up, 44% (n=12) of patients had no PH criteria, 44% (n=12) had residual PH and 11% (n=3) had PH recurrence. There was a reduction of N-terminal pro-B-type natriureticpeptide from 868 (212-1730) pg/mL to 171 (98-382) pg/mL. Rright ventricular systolic function parameters revealed an improvement in longitudinal systolic excursion and peak velocity of the plane of the tricuspid ring from 14 (13-14) mm and 9 (8-10) cm/s to 17 (16-18) mm and 13 (11-15) cm/s, respectively. Of the 26 patients with preoperative right ventricular dysfunction, 85% (n=22) recovered. The proportion of patients on specific vasodilator therapy decreased from 93% to 44% (p<0.001) and the proportion of those requiring oxygen therapy decreased from 52% to 26% (p=0.003). The six-minute walk test distance increased by about 25% compared to the baseline and only eight patients had significant desaturation during the test. Conclusion: Pulmonary endarterectomy performed at an experienced high-volume center is a safe procedure with a very favorable medium-term impact on functional, hemodynamic and right ventricular function parameters in CTEPH patients with operable disease. It is possible for PH centers without PEA differentiation to refer patients safely and effectively to an international surgical center in which air transport is necessary.Introdução e objetivos A tromboendarterectomia pulmonar (TP) é um procedimento potencialmente curativo em doentes com hipertensão pulmonar (HP) tromboembólica crónica (TEC). O objetivo deste trabalho é reportar a experiência inicial de um centro português de tratamento de HP em doentes submetidos a TP num centro de referência cirúrgico internacional. Métodos Estudo observacional prospetivo de doentes consecutivos com diagnóstico de CTEPH seguidos em centro nacional de tratamento de HP e submetidos a TP em centro de referência cirúrgico internacional entre outubro de 2015 e março de 2019. Parâmetros clínicos, funcionais, laboratoriais, imagiológicos e hemodinâmicos foram obtidos nos 12 meses precedentes à cirurgia e repetidos entre quatro a seis meses após a TP. Resultados Foram submetidos a TP 27 doentes consecutivos (59% do sexo feminino) com mediana de 60 (49-71) anos. Durante um seguimento mediano de 34 (21-48) meses, verificou‐se melhoria da classe funcional em todos os doentes, tendo ocorrido apenas um óbito de causa cardíaca. Do ponto de vista hemodinâmico, observou‐se redução da pressão média na artéria pulmonar de 48 (42-59) mmHg para 26 (22-38) mmHg, aumento do débito cardíaco de 3,3 (2,9-4,0) L/min para 4,9 (4,2-5,5) L/min e redução das resistências vasculares pulmonares de 12,1 (7,2-15,5) uW para 3,5 (2,6-5,2) uW. Tendo em conta os parâmetros hemodinâmicos avaliados pós‐TP e a sua evolução durante o seguimento clínico, 44% (n = 12) dos doentes deixaram de ter critérios de HP, 44% (n = 12) mantiveram HP e 11% (n = 3) evoluíram com recorrência de HP. Laboratorialmente, a salientar redução do NT‐proBNP de 868 (212–1730) pg/mL para 171 (98–382) pg/mL. Dos parâmetros de função sistólica ventricular direita, verificou‐se melhoria da excursão e velocidade de pico sistólicas longitudinais do plano do anel tricúspide de 14 (13-14) mm e 9 (8-10) cm/s para 17 (16-18) mm e 13 (11-15) cm/s, respetivamente. Dos 26 doentes com critérios de disfunção sistólica ventricular direita pré‐cirurgia, 85% (n = 22) apresentaram critérios de recuperação. A proporção de doentes sob terapêutica vasodilatadora específica diminuiu de 93% para 44% (p < 0,001) e a proporção daqueles requerendo OLD diminuiu de 52% para 26% (p = 0,003). A distância percorrida no teste dos seis minutos de marcha aumentou em cerca de 25% relativamente ao valor prévio à intervenção cirúrgica e apenas oito doentes mantiveram dessaturação significativa durante a prova. Conclusão A TP realizada em centro cirúrgico de elevado volume é um procedimento seguro e com impacto muito favorável em médio prazo nos parâmetros funcionais, hemodinâmicos e de função ventricular direita em doentes com HPTEC operável. É possível, para centros de tratamento de HP sem diferenciação em TP, a referenciação dos doentes com segurança e efetividade a um centro cirúrgico internacional em que para tal seja necessário aerotransporte.info:eu-repo/semantics/publishedVersio