A Perturbação Obsessiva‑compulsiva em Comorbilidade com a Perturbação do Espectro do Autismo e a Perturbação do Desenvolvimento Intelectual: Caso Clínico

Autism spectrum disorders encompass a wide range of clinical presentations, including obsessive‑compulsive symptoms. The comorbidity between these disorders is significant, and it has therapeutic and prognostic implications. While there are a few references on the approach of such comorbid presentations, the literature is even scarcer when this co‑occurrence is superimposed on individuals with intellectual disability. We present the case of a 43‑years‑old male patient with comorbid treatment refractory obsessive‑compulsive disorder, autism spectrum disorder and intellectual disability, exhibiting subacute symptomatic recurrence including hetero‑aggressive outbursts and contamination obsessions. The phenomenological features and therapeutic strategies are discussed, highlighting the centrality of a patient‑centered and methodologically pluralistic approach. Symptomatic remission was achieved employing high end doses of fluvoxamine and haloperidol, alongside daily psychotherapy involving both symptom‑directed behavioral therapy and supportive psychodynamic techniques. An integrative approach may be the best option in the stabilization of complex cases as the one presented.A perturbação do espectro do autismo abrange uma ampla gama de apresentações clínicas, incluindo sintomas obsessivo‑compulsivos. A comorbilidade entre estas patologias é significativa e tem implicações ao nível do prognóstico e terapêutica. Existem poucas referências bibliográficas sobre a abordagem a este tipo de comorbilidade, sendo a literatura ainda mais escassa quando a esta comorbilidade se sobrepõe uma perturbação do desenvolvimento intelectual. Apresentamos o caso de um doente do sexo masculino de 43 anos com perturbação obsessiva‑compulsiva refratária ao tratamento, comórbida com perturbação do espectro do autismo e compromisso intelectual concomitante, exibindo recorrência sintomática com heteroagressividade e obsessões de contaminação. As características fenomenológicas e estratégias terapêuticas são discutidas, destacando uma abordagem metodologicamente multidimensional e centrada no doente. A remissão sintomática foi alcançada recorrendo a altas doses de fluvoxamina e haloperidol, juntamente com psicoterapia diária envolvendo terapia comportamental e técnicas psicodinâmicas. Uma abordagem integrativa pode ser a melhor opção na estabilização de casos complexos como o apresentado

Discriminação e Barreiras ao Acesso ao Serviço Nacional de Saúde Percecionados por Pessoas Trans

Introduction: Trans people, who need specific medical, surgical and psychological healthcare due to their condition, are confronted with discrimination, prejudice and stigma thus limiting their access to health services. The present study aims to assess barriers in trans health in three distinct public services (emergency, primary care and surgery). Material and Methods: A non‑controlled cross‑sectional study was conducted, using interviews with 71 trans people, after their sexology consult. An interview model was elaborated by the authors, adapting questions from the Trans Pulse Project and the 2015 US Transgender Survey. Results: Half of the trans people who used the services studied perceived discrimination by a healthcare provider. The use of prejudiced language was the most frequent perceived episode of discrimination and the emergency department was the place where it occurred with higher frequency. We found an association between episodes of perceived discrimination in family medicine and the discomfort felt in addressing trans health with the family physician. Discussion: The perceived discrimination felt by trans people was similar to the literature data, in emergency and family medicine services. The lack of knowledge of standards of care by health providers may reinforce barriers to trans healthcare, as seen in the literature. Conclusion: We found the need to study the impact of trans discrimination, around the country, as welll as evaluate and promote trans healthcare amongst healthcare providers.Introdução: A população trans, que necessita de tratamentos médicos, cirúrgicos e psicológicos específicos pela sua condição, é confrontada com discriminação, preconceito e estigma, na procura de serviços de saúde, que limitam o seu acesso. Este estudo pretende avaliar barreiras no acesso à saúde, por esta população, em três ambientes distintos do Serviço Nacional de Saúde (urgência, medicina geral e familiar e cirurgia). Material e Métodos: Realizou‑se um estudo transversal, não controlado, com recurso a entrevista a 71 pessoas trans, após consulta de Sexologia. Um modelo de entrevista foi elaborado pelos autores, adaptando questões do Trans Pulse Project e do 2015 US Transgender Survey. Resultados: Metade dos trans que recorreram aos três contextos estudados percecionaram discriminação por um profissional de saúde. O uso de linguagem preconceituosa foi o episódio de perceção de discriminação mais frequente e o serviço de urgência o local onde ocorreu com mais frequência. Encontramos relação entre episódios de perceção de discriminação em medicina geral e familiar, com o desconforto sentido em abordar saúde trans com o médico de família. Discussão: A discriminação percecionada por pessoas trans foi semelhante à verificada na literatura, em contexto de urgência e medicina geral e familiar. O incumprimento e desconhecimento de guidelines de boas práticas clínicas, por profissionais de saúde, à semelhança da literatura, podem constituir barreiras de acesso a cuidados de saúde, na população estudada. Conclusão: Verificamos que existe a necessidade de estudar, a nível nacional, o impacto da discriminação na população trans, bem como de avaliar e promover a formação de profissionais de saúde nesta área

Water and wastewater monitoring of Guia Submarine Outfall: an 11 year survey

SANEST is a public sanitation company that manages a wastewater treatment plant located at Guia, on the west coast of Lisbon, Portugal. This company collects and treats the sewage of four municipalities with an estimated 750 000 population equivalent, thus being one of the biggest sanitation companies in Portugal. A Decision of the Commission 2001/720/CE conceded SANEST derogation, exempting it to apply less than secondary treatment to wastewaters discharged into the Atlantic Ocean from the four agglomerations. This decision was supported on a large monitoring program, presented to the EU, and set up by SANEST. It surveys the impact of the effluent disposal and includes measurements of physical, chemical, biological and microbiological properties in the effluent and in the receiving waters. This paper presents methods and results for the effluent chemical and microbiological quality as well as for the receiving waters and an ichthyofauna survey, and resumes an eleven year situation, with the preliminary wastewater treatment before effluent disposal. The WWTP results correspond to medium load urban effluents without treatment with temporal variability related to flood fluctuations. In the receiving waters almost legal values are respected and the plume of the outfall is only identifiable by faecal bacteria in the vicinity of the discharge. The fish community, in particular benthic species, has revealed a slight degradation probably due to the fact that pollutants tend preferentially to accumulate on sediment. The treatment plant is being upgraded to fulfil, by May 2009, an advanced primary treatment level that includes disinfection during the bathing season to fully observe the European Commission Decision 2001/720/EC

Application of an E. coli biofilm supported on Kaolin to the removal of Cd(II), Cr(VI), Fe(III) and Ni(II) from aqueous solutions

The pollution caused by heavy metals is one the major environmental problems that is imperative to be solved. New technologies, easy to implement and to adapt to any system, deserve special attention and are the focus of this presentation. This paper aims to investigate the biosorption behaviour of a biofilm of E. coli supported on kaolin clay for the treatment of cadmium, iron, nickel and chromium aqueous solutions. The effect of metals initial concentrations were studied and the relationship between pH and removal efficiency were analysed. Adsorption characteristics of a biosorbent can be depicted by an adsorption isotherm. Langmuir, Redlich-Peterson and Sips are commonly used for the description of adsorption data and were applied to the experimental results described by this report. The presence of functional groups in the suspended biomass that may have a role in biosorption process was confirmed by FTIR. It was demonstrated that a biofilm of E. coli supported on kaolin is able to remove Cr (VI), Cd (II), Ni (II) and Fe (III) from aqueous solutions. The isotherms were fitted and the best fit for chromium and nickel was obtained with the Redlich-Peterson model isotherm and for cadmium the best fit was the obtained with the Sips model. In terms of removal percentage, the results showed 100% of removal for iron for the whole range of concentrations tested. For cadmium, the removal percentage remains around 70% for all the initial concentrations tested (between 67.1% and 78.9%) and is higher than the obtained for nickel and chromium. The analyses by FTIR showed that functional groups on the biomass, such as hydroxyl, carboxyl and phosphate groups, may be the main binding sites for biosorption of the studied heavy metals by E. coli. Finally, the metal affinity to the biofilm was found to follow the sequence Fe > Cd > Ni > Cr and the preference of a sorbent for a metal may be explained on the basis of electronegativity of the metal ions and on the basis of the cation/anion state.Fundação para a Ciência e a Tecnologia (FCT)FEDERMinas de Barqueiros, S.A

2020: Heritage, the pandemic and the journal

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Recent developments with a view to the future

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Conservar Património, a consolidation process

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