Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19

info:eu-repo/semantics/publishedVersio

Um Portugal de imigrantes: exercício de reflexão sobre a diversidade cultural e as políticas de integração

Apesar da pluriculturalidade que caracteriza algumas regiões de Portugal, existe um desconhecimento e por vezes resistência, em particular das comunidades mais tradicionais e das gerações mais antigas, na aceitação dos imigrantes que escolhem o nosso País como destino de acolhimento. Conhecer as comunidades imigrantes pode ajudar a perceber e a minimizar as dificuldades do convívio pluricultural. Este será, na atualidade, um dos papéis que o animador sociocultural será chamado a desempenhar. Para isso, é necessário que reconheça os recursos legais, metodológicos e teóricos que tem ao seu dispor, sendo estas as premissas que norteiam o presente exercício. Esta análise nasceu de uma proposta de trabalho da Unidade Curricular de Multiculturalidade e Cidadania, mas rapidamente se revelou um importante contributo para o conhecimento da diversidade cultural no nosso país. Após uma contextualização teórica relativa aos principais fluxos migratórios em Portugal, é apresentada a análise dos dados relativos à composição das origens dos imigrantes em Portugal na atualidade e a sua distribuição pelo território português. Este é o ponto de partidapara a reflexão que se lhe seguiu, que visa, por um lado, identificar algumas das problemáticas que resultam dos contextos de diversidade cultural e, por outro, conhecer as propostas do Estado para promover a integração do “outro”. Estes pilares sustentaram a abordagem final relativa ao papel da Animação Sociocultural (ASC) e do animador neste contexto.Abstract Portugal has been a pluricultural country since early times. Notwithstanding, Portuguese society is mostly unaware of this fact and is not always open to cultural diversity. Social and cultural workers may have an important role managing inter cultural conflicts. In order to do so, these professionals need to acknowledge the importance of theoretical social principles and scientific research to effectively intervene in multicultural contexts. These arguments support the present exercise, developed during Multiculturalism and Citizenship classes (lectured at Escola Superior de Educação de Lisboa – Instituto Politécnico de Lisboa, 2012- 2013). We present a brief analysis regarding migration patterns to Portugal followed by a data analysis concerning their geographical origin and distribution in Portuguese territory. An overview on the problems regarding cultural diversity and foreigner acceptance is also presented. Finally, we debate on the role played by the social and cultural worker in today‟s globalized and diverse societyRésumé La pluriculturalité qui caractérise certaines régions du Portugal n‟est pas reconnue par tous les citoyens et est, parfois, associée à une certaine résistance quant à l‟acceptation des immigrants qui choisissent notre pays comme destination d‟accueil. L‟animateur socioculturel peut avoir un rôle prépondérant dans la gestion de la diversité culturelle. C‟est pourquoi, il est important qu‟il soit conscient, tout d‟abord, du besoin d‟investir dans la formation et la recherche théoriquement fondée portant sur la réalité qui l‟entoure et où il pourra être amené à travailler et ensuite, qu‟il connaisse les caractéristiques de la société moderne et globale dans laquelle il vit. Ce sont les deux prémisses qui orientent le présent exercice qui est issu d‟une proposition de travail de l‟Unité Curriculaire de Multiculturalité et Citoyenneté mais qui rapidement, s‟est révélé un apport considérable pour la connaissance de la diversité culturelle. Après une contextualisation théorique relative aux principaux flux migratoires au Portugal, sont présentées et analysées des données relatives à la composition des origines des immigrants au Portugal actuellement et leur distribution sur le territoire portugais. C‟est le point de départ pour la réflexion qui s‟en est suivie. La réflexion prétend d‟une part, identifier certaines des problématiques qui proviennent des contextes de diversité culturelle et d‟autre part, connaître les propositions de l‟Etat pour promouvoir l‟intégration de « l‟autre » qui peut être, plus ou moins, en marge de la société portugaise. Ces piliers soutiennent l‟abordage final relatif au rôle de l‟animateur socioculturel dans ces contextes pluriculturels

Risk Factors for Acute Surgical Site Infection after Spinal Instrumentation Procedures: A Case-Control Study

Background: Surgical site infection (SSI) prevalence in spinal instrumentation varies, depending on patient and surgery factors. This study aims to identify patient- and procedure-related factors associated with SSI after spinal instrumentation in 3 patient-specific groups: those undergoing surgery for degenerative, trauma-related, and pediatric deformity conditions. Methods: A case-control (1:2 ratio) analysis of SSI after spinal instrumentation, from 2009 to 2017, in a University Hospital and Spinal Trauma Centre was performed. Results: From a total of 2582 surgeries, 33 cases (1.3%) were identified with SSI according to study inclusion criteria: 14 (out of 1326) in the degenerative group, 11 (out of 207) in the trauma group, and 8 (out of 850) in the pediatric deformity group. Cases were matched with controls (n = 66) of the same group. Univariate analysis identified procedure and anesthesia duration in the degenerative group (P = .032 and .038, respectively), age (P = .014) and need for intraoperative and postoperative blood transfusions (both P = .039) in the trauma group and American Society of Anesthesiologists score (P = .022) and neuromuscular scoliosis (P = .002) in the pediatric deformity group as associated with SSI. After multivariate analysis, procedure duration was independently associated with SSI in degenerative surgery (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.03-4.82) and procedure duration (OR, 3.79; 95% CI, 1.27-11.32) and number of levels instrumented (OR, 11.77; 95% CI, 1.55-89.40) in the trauma group. Conclusions: This study identified procedure duration as a risk factor for SSI after spinal instrumentation in degenerative and trauma spine surgery and the number of levels instrumented in trauma spine surgery. Awareness of these factors will help develop strategies to improve patient and health system overall outcomes.info:eu-repo/semantics/publishedVersio

Persistência do canal arterial em recém-nascidos pré-termo

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018O canal arterial (CA) consiste numa ligação vascular fetal entre a artéria pulmonar principal e a aorta, que normalmente encerra pouco tempo após o nascimento. Define-se persistência do canal arterial (PCA) quando este não encerra após as 72 horas de vida. O encerramento do canal é atrasado em recém-nascidos (RN) pré-termo e o risco de PCA é inversamente proporcional à idade gestacional (IG). Em RN com PCA, o shunt esquerdo-direito resulta num excesso de fluxo através da circulação pulmonar e hipoperfusão sistémica. Esta condição foi associada a um risco aumentado de morbilidade e mortalidade. O diagnóstico geralmente é baseado no quadro clínico e confirmado por ecocardiografia. A abordagem terapêutica da PCA inclui: abordagem conservadora utilizando apenas medidas de suporte, encerramento farmacológico e cirúrgico. Ainda existe incerteza e controvérsia acerca da melhor abordagem diagnóstica e terapêutica da PCA em RN pré-termo, resultando numa grande heterogeneidade na prática clínica entre as diferentes unidades de cuidados intensivos neonatais (UCIN). São necessários ensaios controlados e aleatorizados para comparar as diferentes opções terapêuticas, relativamente à sua eficácia, segurança e resultados a longo prazo, de modo a determinar a mais adequada e se existe algum subgrupo de doentes que beneficie de uma abordagem em detrimento de outra.The ductus arteriosus (DA) is a fetal vascular connection between the main pulmonary artery and the aorta that normally closes soon after birth. A patent ductus arteriosus (PDA) occurs when the ductus fails to close after 72 hours of life. Ductal closure is delayed in preterm infants and the risk of PDA is inversely proportional to gestacional age (GA). In infants with a PDA, the left-to-right shunt of blood results in an excessive blood flow through the pulmonary circulation and hypoperfusion of the systemic circulation. This condition has been associated with increased risk of morbidity and mortality. The diagnosis is usually based upon its characteristic clinical findings and confirmed by echocardiography. Management of PDA includes: conservative management with supportive care alone, pharmacologic and surgical closure. There is still uncertainty and controversy about the significance, evaluation and management of PDA in preterm infants, resulting in substantial heterogeneity in clinical practice amongst different neonatal intensive care units (NICU). Randomized controlled trials comparing the different therapeutic options regarding their efficacy, safety and long-term outcomes are needed, in order to ascertain the optimal management approach and whether clinical parameters may favor one approach over another

Winter sowing and higher populations as dry-farming strategies on sunflower crop (Helianthus annuus L.)

Sunflower is sown in early spring (March-April) under Mediterranean dryland conditions. Plant development is coincidental with increasing air temperature and crop ET and usually reproduction occurs under water and temperature stresses, resulting in severe yield limitations (Downes 1975, Carvalho et al 1990, 1991). As a strategy of stress avoidance during the reproductive stages winter sowing (late December and January) has been successfully tested (Vesperinas et al 1991, Ordonez 1990). This experiment tested the potential advantage in anticipating sowing date to late December or January, and in increasing plant population in order to use soil water more efficiently

Consumo de suplementos vitamínicos em jovens do ensino superior público do Distrito de Bragança

O actual ritmo de vida acelerado e a má alimentação das pessoas, em especial dos estudantes, obriga, muitas vezes, ao uso irracional de suplementos vitamínicos. O presente artigo pretende descrever e analisar os hábitos de consumo de Suplementos Vitamínicos (SV) e os factores que influenciam este consumo, numa amostra de 460 alunos das várias escolas do IPB, extraída de uma população total de 7064 alunos, utilizando um estudo descritivo, transversal, de natureza quantitativa. Os dados foram obtidos através da aplicação de um questionário de auto-preenchimento, anónimo e voluntário, sendo sujeitos a tratamento estatístico através do programa SPSS 17.0 para Windows. A partir dos resultados foi possível concluir que 47,6% dos alunos questionados consome ou já consumiu SV, sendo os mais consumidos Centrum (40,2%), Cerebrum (27,4%) e Magnesium (20,6%), e os menos consumidos Amundsen, Bioelectra, CerealG, Cergumil, Panvitol, Tonosol e Vittol, não assinalados por nenhum dos inquiridos. Relativamente às variáveis em estudo (Género; Idade; Meio de onde provém; Escola; Grau Académico; Curso e Ano em que se encontra), nenhuma delas demostrou ter relação com o consumo de SV

Impact of COVID-19 pandemic and national lockdown in an orthopaedic and traumatology department—a comparison with the homologous period of 2019

Background: The coronavirus disease-2019 pandemic has forced health systems to undergo dynamic changes. This study aims to evaluate the impact of the pre-lockdown and of the lockdown period on the surgical activity of a Portuguese Orthopaedic and Traumatology Department and to compare it with the homologous period of 2019. Methods: The surgical activity between March 2 and May 2, 2020 and that of the homologous period of 2019 were analyzed and compared. Additionally, the impact of national and institutional measures was analyzed. Results: There was a decrease in elective surgeries, from 587 to 100. In 2020, 59.3% of all surgeries were urgent and 48.4% were trauma whereas in 2019 there were 25.5% urgent and 23.0% trauma surgeries (P < .001 and P < .001, respectively). There was no difference in the mean of proximal hip fractures operated per week (P = .310), even when analyzing only the lockdown period (P = .102). However, proximal hip fractures corresponded to significantly higher proportion of surgeries in 2020 (P = .04). Hand and tendon injuries significantly reduced in 2020, as were sports-related trauma surgeries. Mean number of days until surgery was significantly lower in 2020 (2020:1.6 ± 2.1, 2019: 2.2 ± 2.5, P = .012). Conclusion: Governmental and institutional measures had high impact on the production and on the epidemiology of trauma. While resumption of elective surgery is needed, lessons from these measures may help in the response to a possible second wave.info:eu-repo/semantics/publishedVersio

Textile depilling : superior finishing using cellulose-binding domains with residual enzymatic activity

Textile fabric depilling is an important industrial application of cellulases. The depilling effect and achievement of desirable touch properties are among the applications sought by users. This process, although effective, is associated with significant tensile strength loss. The depilling mechanism is still a subject of controversy. In this work, we introduce a new perspective in understanding of the depilling mechanism, specifically we consider the contribution of interfacial properties. Cellulose Binding Domains (CBDs) obtained by ultrafiltration after digestion with a protease, were used in depilling experiments. Compared with cellulose, the performance of CBDs was very positive. In fact, when using CBD with residual hydrolytic activity, it was possible to achieve superior depilling treatments

Textile depilling : use of enzymes and cellulose binding domains

Textile fabrics biopolishing is one of the most important industrial application of cellulases. These are widely used to remove fibrils and fuzz fibres from cotton fabrics, or to produce the “stone-washed” look of denim garments. The depilling effect and the achievement of desirable touch properties are among the applications sought by the users. This process, although effective, is associated to a significant tensile strength loss. The biopolishing mechanism is still the subject of controversy. Interfacial properties are not considered in the removing of the pills. It is believed that the hydrolytic activity of cellulases is the only responsible process for the biopolishing. In this work, we aim at introducing a new perspective in the understanding of the biopolishing mechanism, specifically we consider the contribution of interfacial properties. Cellulose Binding Domains (CBD) with a much lower hydrolytic activity than cellulases were produced in laboratory by ultrafiltration after digestion with a protease. Some were purified by ion-exchange chromatography to reduce even more catalytic activity. Cotton fabrics were treated with different cellulases and the CBD. Soluble sugars, tensile strength loss and pilling degree were measured to evaluate the effect of enzymes and CBD, to understand the tensile strength loss and to conclude if interfacial properties are important in the biopolishing process

How to prepare a power system for 12% wind energy penetration: The Portuguese Case Study

The 2001/77/CE Renewable Energies European Directive together with Kyoto Protocol ratification supported by a Government vision and strong objective on the reduction of external oil dependence put Portugal in the front line to achieve one of the highest wind energy penetrations within ten years time. This paper gives a summarized overview of the Portuguese technical approaches and methodologies followed in order to plan and accomodate the ambitious wind power goals to 2010/2013, preserving the overall quality of the power system