Normas, nomenclaturas e uniformização do registo clínico

Dissertação de mestrado integrado em Engenharia BiomédicaA crescente utilização dos Sistemas de Informação (SI) nas unidades de saúde tem um papel muito importante para garantir a qualidade das mesmas. Com as Tecnologias da Informação e da Comunicação (TIC), os dados armazenados estão estruturados e organizados de forma a possibilitar uma utilização rápida e e caz. O aumento de informações em formato eletrónico no processo de Registo Clínico (RC) apesar de diminuir em grande escala erros que resultavam da utilização de dados mal entendidos, trouxe um desa o aos técnicos de informática médica. Esse desa o passa por melhorar a qualidade da prestação de cuidados de saúde utilizando a informação armazenada. É neste âmbito que surgem as normas e sistemas de nomenclatura que possibilitam uma uniformização do RC de forma a evitar dados ambíguos e permitir a comunicação entre diferentes pro ssionais de saúde e serviços hospitalares. Estas normas são divididas conforme a sua nalidade, havendo normas de comunicação, imagem e representação. Pretende-se, neste contexto, implementar o Systematized Nomenclature of Medicine (SNOMED) na Agência de Interoperação, Difusão e Arquivo (AIDA) no Centro Hospitalar do Alto Ave (CHAA) de forma a utilizar as suas potencialidades no processo de uniformização do Registo Clínico Eletrónico (RCE).The increasing use of Information Systems in health units has a very important role to ensure their quality. With Information and Comunication Technologies, the stored data are structured and organized in order to enable a fast and e ective utilization. The increase of information in electronic format in the process of Health Record while decreasing large-scale errors that resulted from the use of data misunderstandings brought a technical challenge to medical informatics. This challenge involves improving the quality of health care using the stored information. It is in this context that arise standards and naming systems that enable uniformity in the medical record in order to avoid ambiguous data and allow communication between di erent healthcare professionals and hospital services. These standards are divided according to their purpose, having communication, image and representation standards. It is intended, in this context, implementing the SNOMED in AIDA at the CHAA in order to use their potentialities in the process of standardization of the Electronic Health Record

An overview of high‐entropy alloys as biomaterials

This work was partially funded by national funds through the FCT-Fundacao para a Ciencia e a Tecnologia, I.P., under the scope of the project UIDB/50025/2020-2023.High‐entropy alloys (HEAs) have been around since 2004. The breakthroughs in this field led to several potential applications of these alloys as refractory, structural, functional, and biomedical materials. In this work, a short overview on the concept of high‐entropy alloys is provided, as well as the theoretical design approach. The special focus of this review concerns one novel class of these alloys: biomedical high‐entropy alloys. Here, a literature review on the potential high‐entropy alloys for biomedical applications is presented. The characteristics that are required for these alloys to be used in biomedical‐oriented applications, namely their mechanical and biocompatibility properties, are discussed and compared to commercially available Ti6Al4V. Different processing routes are also discussed.publishersversionpublishe

QUILOPERITONEU APÓS GASTRECTOMIA: É UM PESADELO CONTROLÁVEL?

Chylous ascites is a serious and rare complication after gastrectomy for gastric cancer. Most cases improve with conservative treatment, but substantial morbidity and mortality can be associated. We describe the case of a 48-year-old-male submitted to partial gastrectomy with D2 lymphadenectomy for gastric adenocarcinoma. Three days after starting a liquid diet, it was diagnosed a chyle fistula. Conservative treatment was started with improvement of the patient and he was discharged. After eighteen days, the patient was readmitted due to a large volume chyloperitoneum, requiring paracentesis. Medical treatment was reinstituted, with amelioration and dismissal of the patient. The patient returned to the emergency department due to abdominal pain and fever and was submitted to laparoscopic abdominal drainage. There was resolution of refractory ascites during hospitalization. Chylous ascites is a rare complication after radical resections for gastric cancer. Therefore, there is no well-defined treatment and these cases remain a therapeutic challenge. The therapeutic strategies described include dietary measures, the use of pharmacological agents, total parenteral nutrition and, in selected cases, surgical or percutaneous interventions.A ascite quilosa é uma complicação grave e rara após gastrectomia por cancro gástrico. A maioria dos casos melhora com tratamento conservador, mas morbidade e mortalidade substanciais podem estar associadas. Descrevemos o caso de um homem de 48 anos submetido a gastrectomia parcial com linfadenectomia D2 por adenocarcinoma gástrico. Três dias após início de dieta líquida, foi diagnosticada fístula de quilo. Foi iniciado tratamento conservador com melhora do paciente e ele recebeu alta. Após dezoito dias, o paciente foi readmitido por apresentar quiloperitônio de grande volume, necessitando de paracentese. O tratamento médico foi reinstituído, com melhora e alta do paciente. O paciente retornou ao pronto-socorro por dor abdominal e febre e foi submetido à drenagem abdominal laparoscópica. Houve resolução da ascite refratária durante a internação. Ascite quilosa é uma complicação rara após ressecções radicais para câncer gástrico. Portanto, não existe um tratamento bem definido e esses casos permanecem um desafio terapêutico. As estratégias terapêuticas descritas incluem medidas dietéticas, uso de agentes farmacológicos, nutrição parenteral total e, em casos selecionados, intervenções cirúrgicas ou percutâneas

Rapid granulation and stable performance of a microalgal-bacterial granular sludge system treating saline wastewater

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Efficient ammonium removal from marine aquaculture wastewater with microalgal-bacterial granular sludge technology

Water recirculation in marine aquaculture is fundamental for the protection of water resources and for the sector sustainability as it enables to reduce water usage 1. Microalgal-bacterial granular sludge (MBGS) has the potential to increase the removal efficiency of pollutants from wastewaters benefiting from the diverse metabolism allowing water recirculation. Moreover, MBGS would allow costs reduction both in biomass separation from the treated water given the rapid settling properties and in aeration due to microalgae oxygen production 2.This study aimed to develop MBGS able to treat marine aquaculture effluents. For that, a lab-scale photo sequencing batch reactor was inoculated with activated sludge, previously adapted to salty wastewater, and a microalgae consortium enriched from water collected at a marine aquaculture. Feeding composition was established to simulate marine aquaculture streams. The aggregation of microalgal and bacterial biomass to form granular structures occurred rapidly. Throughout the operation, dark green granules with a dense and compact structure became predominant together with an increase in chlorophyll and carotenoids content in biomass. Ammonia was absent from the reactor effluent, but the nitrite levels were often above the toxicity levels for fish. Nevertheless, the dissolved oxygen concentration in the treated water was high (> 8.63 mg/L). The microalgal-bacterial granules proved to be efficient in producing streams with high dissolved oxygen levels, lowering the needed of water oxygenation before reuse and without ammonium ions. However, for water recirculation, improvement of the nitrite removal is needed to maintain the levels below the fish toxicity levels.info:eu-repo/semantics/publishedVersio

Microalgae-bacterial granular sludge systems - on the road for more sustainable processes in the aquaculture sector

With population growth and stagnation of capture fisheries, the aquaculture sector has been challenged to achieve remarkable production targets to meet the ever-increasing fish demand. However, land-based aquaculture industries need to capture high water volumes from nearby water bodies to ensure an adequate production and, consequently, high wastewater volumes, containing organic carbon, nutrients, and often contaminants of emerging concern, are produced. If not properly handled, aquaculture effluents pose a threat to receiving aquatic ecosystems. The rapid expansion of these industries, facing the increased demand for food worldwide, is only possible if more sustainable practices are adopted. To face the current water shortages and protect water resources, the development of environmentally friendly treatment systems that allow water recirculation is of utmost importance. This work aimed to develop a microalgae-bacteria granular sludge system able to efficiently treat marine aquaculture effluents so they can meet the requirements for recirculation. A photo-sequencing batch reactor was inoculated with a phototrophic microbial consortium obtained from water streams in a marine aquaculture facility and was fed with wastewater mimicking marine aquaculture streams. The aggregation of the microbial biomass occurred rapidly and, on day-21, ca. 49% of the total reactor biomass was in the form of granules. The system exhibited high and stable organic carbon removal (>80%), even when florfenicol, an antibiotic widely used in aquaculture, was present in the wastewater. Concerning the nitrogen content, a high-chemical quality effluent was obtained, complying with ammonium, nitrite, and nitrate concentrations for water recirculation within a marine aquaculture farm, even in periods where florfenicol was present in the wastewater. In addition, the dissolved oxygen levels in the treated effluents where within the ideal range for fish growth thus reducing the need for oxygenation and, consequently, the farms operational costs. Additionally, the coexistence of microalgae and bacteria within the granules allowed to treat wastewater at low air flow rates potentially reducing the energy needed for system’s aeration. Microalgae-bacterial granular sludge systems can contribute for the aquaculture sector sustainability as they enable to reduce energy and water usage whilst ensuring environmental protection.info:eu-repo/semantics/publishedVersio

Aerobic granules synthesized with EPS and degrading strain Rhodococcus FP1 for industrial wastewater treatment

Aerobic granular sludge-sequencing batch reactors (AGS-SBR) is a promising and innovative wastewater treatment system. AGS is composed of microorganisms embedded in a self-produced extracellular polymeric substances (EPS) matrix, forming spherical sludge aggregates. Although AGS tolerance to toxicity, the indigenous microbial communities may not be effective in removing recalcitrant pollutants. Bioaugmentation strategies (addition of specific microorganisms to the system) can be a solution to overcome the difficulty to eliminate certain compounds in wastewaters. However, it is still not a well-established strategy. EPS was extracted from aerobic granules from Nereda® wastewater treatment plants in Utrecht or Garmerwolde, Netherlands. The extraction procedure is as described by Felz et al., 2016. The synthetic granules were produced using the extrusion technique with CaCl2, by mixing the extracted EPS, a concentrated bacterial suspension of Rhodococcus sp FP1 (OD450 of 67.0), and substances 1 or 2. The produced synthetic granules were subjected to a shear stress test, 400 or 800 rpm in a closed vessel for 1 hour, in order to measure their strength. A specific mixture composed of EPS, bacterial suspension and substance 2 generated strong synthetic granules, similar to Utrecht granules used as a control in the shear stress test. Beads produce only with substance 2 and bacterial suspension showed to be weaker than the granules previously mentioned. Thus, the EPS can be considered a key component to increase the strength of the synthetic granules. However, some inconsistencies were observed for synthetic granules with higher concentration of EPS and substance 2, which could indicate that the composition and crosslinking potential of the EPS could be the limiting factor for the granules strength and not only the EPS concentration. In summary, EPS composition and concentration can be important factors to be considered when synthesizing strong granules able to endure this shear stress test. In the future, the EPS biocompatibility and 2-fluorophenol biodegradation with these synthetic granules will be tested.info:eu-repo/semantics/publishedVersio

Bioaugmentation of Aerobic Granular Sludge with specialized degrading granules treating 2-fluorophenol wastewater

The industry growth has been accompanied by an increase in the amount of industrial chemicals being released into the environment. Indigenous microbial communities in wastewater biotreatment processes are not always effective in removing xenobiotics. This work aimed to evaluate the efficiency of a new bioaugmentation strategy in an aerobic granular sludge sequencing batch reactor (AGS-SBR) system fed with 2-fluorophenol (2-FP). Bioreactor performance in terms of phosphate and ammonium removal, 2-FP degradation and chemical oxygen demand (COD) was evaluated. The new bioaugmentation strategy consisted in producing granules using extracellular polymeric substances (EPS) extracted from AGS as a carrying matrix and a 2-FP degrading strain, Rhodococcus sp. FP1. The produced granules were used for the bioaugmentation of a reactor fed with 2-FP. Shortly after bioaugmentation, the produced granules broke down into smaller fragments inside the bioreactor, but 2-FP degradation occurred. After 8 days of bioaugmentation, 2-FP concentration inside the reactor started to decrease, and stoichiometric fluorine release was observed 35 days later. Phosphate and ammonium removal also improved after bioaugmentation, increasing from 30% to 38% and from 20 to 27%, respectively. Complete ammonium removal was only achieved when 2-FP feeding stopped, and phosphate removal was not recovered during operation time. COD removal also improved after the addition of the produced granules. The persistence of Rhodococcus sp. FP1 in the reactor was followed by qPCR. Rhodococcus sp. FP1 was detected 1 day after in the AGS and up to 3 days after bioaugmentation at the effluent. Nevertheless, the 2-FP degradative ability remained thereafter in the granules. Horizontal gene transfer could have happened from the 2-FP degrading strain to indigenous microbiome as some bacteria isolated from the AGS, 3 months after bioaugmentation, were able to degrade 2-FP. This study presents a promising and feasible bioaugmentation strategy to introduce specialized bacteria into AGS systems treating recalcitrant pollutants in wastewater.N/

Recycling of marine aquaculture wastewater using a microalgae-bacterial granular sludge system

Aquaculture has become the fastest growing animal food-producing sector. In a near future, an intensification of the aquaculture practices is expected to cope with the ever-increasing fish demand. However, for land-based aquaculture farms, this growth implies the capture of higher water volumes from nearby water bodies and, consequently, the discharge of higher volumes of wastewater, containing organic carbon, nutrients, and often recalcitrant pollutants (e.g. pharmaceuticals). The expansion of the land-based aquaculture sector is currently offset due to the lack of space and water supplies, but also due to environmental concerns. Therefore, there is a need for innovative wastewater treatment systems able to reduce energy input, to improve resource use and to reduce the environmental impact. In the present study, microalgae-bacterial granules were developed from a phototrophic microbial consortium autochthonous to the water streams of a marine aquaculture facility. The granular biomass was able to efficiently treat marine aquaculture streams, even when sporadically the antibiotic florfenicol was present, with pollutant reaching levels that allowed water recirculation in fish farms. The ammonium, nitrite, and nitrate concentrations in the treated effluents were below the toxicity limits for marine fish and, the dissolved oxygen levels were within the ideal range for water recirculation. The granules microbial community was dynamic and, its structure was susceptible and adaptable to the changing operational reactor conditions such as the presence of the antibiotic florfenicol. The microbial diversity and functional redundancy within the microbial community seemed to be crucial for the adaptability of the system to the stressors presence. Th symbiosis established between microalgae and bacteria within granules allowed for the effective and environmentally sustainable treatment of marine aquaculture wastewater.info:eu-repo/semantics/publishedVersio