Uniformização dos métodos de avaliação do estado de conservação de edifícios definidos no quadro legal português

Dissertação para obtenção do Grau de Mestre em Engenharia Civil - Perfil de Construção

Association of chagasic megacolon and cancer of the colon: case report and review of the literature

There are few descriptions of association between chagasic megacolon and colon cancer. We report a case of obstructive abdomen caused by adenocarcinoma of the left colon in chagasic megacolon. A review of the literature revealed 8 cases of this association and, analyzing together the series of findings of cancer in chagasic organomegalies, we found a frequency of 4.8% in megaesophagus and 0.1% in megacolon.

Análise comparativa do direito de acesso a cuidados de saúde no serviço nacional de saúde português e sistema de saúde norte-americano (EUA)

RESUMO - O presente estudo situa-se nas áreas gerais da Saúde Pública, dos Sistemas de Saúde e do Acesso à Prestação de Cuidados de Saúde e procura analisar o conteúdo e concretização do Direito de Acesso a Cuidados de Saúde na perspectiva de dois sistemas de saúde paradigmaticamente distintos, um sistema de acesso universal, representado pelo Serviço Nacional de Saúde português e um sistema de saúde de “não universal”, cujo paradigma é o modelo existente nos Estados Unidos da América, onde entidades gestoras de cuidados, Managed Care Organizations, são chamadas a desempenhar um papel central no acesso e prestação de cuidados de saúde. O vasto campo de investigação representado pela problemática do acesso a cuidados de saúde e a necessidade de limitar o trabalho de investigação subjazem à definição de quatro vertentes a analisar: (a) a existência ou não de uma base legal que preveja e regule o exercício do direito de acesso a cuidados de saúde; (b) o conteúdo deste direito no âmbito de cada um dos sistemas em estudo; (c) as condições de concretização do acesso a cuidados de saúde em ambos os sistemas, e, por último (d) a existência de garantias de efectivação do mesmo. Analisados os sistemas em estudo à luz das vertentes apresentadas, concluímos que a existência de um quadro normativo próprio, que explicite o conteúdo e condições de efectivação do direito, apresenta maiores garantias de concretização do exercício do Direito de Acesso a Cuidados de Saúde, entendendo-se que um sistema de acesso dependente da actuação de entidades gestoras de cuidados não beneficia o acesso a cuidados de saúde, nomeadamente por não garantir equidade no momento de procura e necessidade de cuidados. Os dados apresentados foram recolhidos através do recurso a uma metodologia qualitativa. A análise documental foi aplicada na recolha dos dados relativos à evolução e caracterização dos sistemas, bem como às condições de acesso. No âmbito do sistema de saúde de acesso universal, ou seja, o caso português, procedeu-se essencialmente à análise dos normativos aplicáveis. No que se refere ao sistema de saúde norte-americano, na ausência de base legal aplicável, recorreu-se sobretudo à análise de literatura e documentos. A participação no vi Second Biennal Seminar in Law and Bioethics1 e na 30th Annual Health Law Professors Conference2, realizados em Bóston, EUA, em Julho de 2007, permitiram uma melhor percepção da actual situação da prestação de cuidados naquele País, nomeadamente de algumas das reformas em curso, bem como um melhor entendimento das características do sistema prestador norte-americano em si mesmo. 1 Seminário organizado nos dias 30 e 31 de Maio, numa colaboração entre a Escola Nacional de Saúde Pública e o Departamento de Direito da saúde, Bioética e Direitos Humanos da Escola de Saúde Pública da Universidade de Bóston, sob o tema: “Law and ethics in rationing Access to care in a high-cost global economy”. A nossa participação deveu-se a um convite da Prof.ª Paula Lobato de Faria para colaborar na sessão sobre o sistema de saúde português. 2 Reunião realizada em Bóston nos dias 31 de Maio a 2 de Junho, sobretudo a sessão dedicada ao tema “New Models for Reform”, sobre os novos modelos de sistema de saúde em desenvolvimento nos EUA.

Testes genéticos de venda direta ao consumidor : questões ético-legais no mercado português

RESUMO - As descobertas realizadas na área da genética levaram ao desenvolvimento de aplicações práticas, entre as quais se destacam os testes genéticos, cujas aplicações em saúde tiveram um impacto considerável na prática clínica. Uma das consequências deste desenvolvimento foi o nascimento de um novo mercado na área da saúde, o mercado dos Testes Genéticos de Venda Direta ao Consumidor (TGVDC). Este mercado está associado a questões do foro ético e legal muito específicas e importantes. Através da realização do presente trabalho de projeto pretende-se analisar e discutir as principais questões éticas e legais suscitadas pelos TGVDC, com maior enfoque no mercado português e na aplicação do enquadramento ético-legal em vigor em Portugal. No que toca à metodologia, no âmbito do presente trabalho de projeto, realizou-se uma análise da literatura científica e ético-legal do tema em estudo. Posteriormente realizou-se uma entrevista exploratória, a uma personalidade de reconhecido mérito na área da genética humana, a fim de compreender quais as principais questões suscitadas pelo mercado de TGVDC. Seguidamente realizou-se um mapeamento das entidades que operam no mercado de TGVDC, seguido de um inquérito a essas mesmas entidades, a fim de avaliar as características do serviço oferecido em Portugal e a aplicação do regime normativo ético-legal em vigor. Verificou-se, como era expectável, que o mercado português de TGVDC apresenta reduzida dimensão quando comparado com outros mercados a nível internacional, designadamente o mercado norte-americano que é, claramente, o mais desenvolvido nesta área. Os resultados obtidos apontaram ainda, no que toca à realidade portuguesa, para a pertinência de questões discutidas na literatura analisada. Em suma, apesar das limitações inerentes à realização de um projeto pioneiro e ambicioso num curto espaço de tempo, as conclusões deste trabalho permitem extrair conclusões importantes acerca do mercado português de TGVDC, sob a perspetiva ético-legal, bem como efetuar recomendações importantes para futuros estudos nesta área.

Oropharyngeal histoplasmosis: report of eleven cases and review of the literature

INTRODUCTION: Histoplasmosis is a systemic mycosis endemic in Brazil, especially in the State of Rio Grande do Sul, where Histoplasma capsulatum was isolated from the soil. H. capsulatum may compromise unusual areas, including the oropharynx, particularly in patients presenting disseminated histoplasmosis; which is associated with a state of immunosuppression, such as AIDS. METHODS: During database analysis of a total of 265 cases of histoplasmosis, the medical records of 11 patients with histological or microbiological diagnoses of oral histoplasmosis (OH) between 1987 and 2008 were retrospectively reviewed. RESULTS: This work reports 11 cases of OH, the majority presenting histopathological or microbiological evidence of disseminated histoplasmosis (DH). In the patients with DH, OH was the first manifestation of histoplasmosis. Five of the 11 patients discussed were HIV-seropositive with clinical and laboratory findings of AIDS. Four patients presented active pulmonary tuberculosis concomitant with histoplasmosis. Treatment was based on the use of itraconazole and amphotericin B deoxycholate. Eight patients responded successfully to therapy after one year, two did not come back for reevaluation and one died despite adequate therapy. CONCLUSIONS: Oral histoplasmosis is closely associated with immunosuppression status, especially in patients presenting AIDS; moreover, in many cases, OH is the first sign of disseminated histoplasmosis.

Human herpesvirus 6: report of emerging pathogen in five patients with HIV/AIDS and review of the literature

The reactivation of human herpesvirus 6 (HHV-6) in patients with AIDS can result in an acute and severe diffuse meningoencephalitis. We describe the epidemiological, clinical and outcome findings of five patients with diagnosis of HIV/AIDS and central nervous system involvement (CNS) due to HHV-6. Fever was present in all the patients. Meningeal compromise, seizures and encephalitis were present in some of the patients. Polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) specimens was positive for HHV-6 in all the patients. HHV-6 should be included among opportunistic and emerging pathogens that involve the CNS in patients with AIDS.

Acute meningoencephalomyelitis due to varicella-zoster virus in an AIDS patient: report of a case and review of the literature

Varicella-zoster virus (VZV) meningoencephalomyelitis is a rare but severe neurological complication of VZV reactivation in immunocompromised patients. We report the case of an HIV-infected individual who developed an acute and severe meningoencephalomyelitis accompanied by a disseminated cutaneous eruption due to VZV. The presence of VZV DNA in cerebrospinal fluid was confirmed by polymerase chain reaction (PCR) technique. The patient started undergoing an intravenous acyclovir therapy with a mild recovery of neurological manifestations. Varicella-zoster virus should be included as a cause of acute meningoencephalomyelitis in patients with AIDS. Early diagnosis followed by specific therapy should modify the rapid and fulminant course for this kind of patients.

A segurança das infraestruturas críticas em Portugal

Portugal, having responsibilities at European level, needs to ensure compliance with European standards, particularly with regard to the European Security Plan for Critical Infrastructures. National critical infrastructures should be a focus of attention with regard to the management of public risks, since these represent "a set of services that are essential to the functioning of the country and the functioning of the forces that ensure national defense." (Soares, 2008) This contribution on national critical infrastructures (CI) has the essential objective of clarifying the development of the strategy adopted by Portugal in pursuit of the security of these fundamental infrastructures. The goal lies not only through producing a descriptive document, but also carry a brief confrontation between the legal framework related to these subjects and the reality in which the Critical Infrastructure Operators and the National Civil Protection Authority (ANPC) operate. It is intended, in this sense, to understand the development of the project for the national security program of critical infrastructures and what effects of its measures on operators. As for the methodology, we followed a methodological strategy, where we combine the literature with data obtained through semi-structured interviews. Portugal, being a geographically peripheral country and having no record of incidents capable of causing major contingencies in key services for the normal development of society, does not have a structured and regulator plan that substantiates the need for operators responsible for CI to invest in security. This same approach is expected at the State level, believing that even though this theme has be widely explored by international institutions, Portugal has not yet tried to give the attention it deserves. Without the existence of an institution and a regulatory system, CI operators can become less available to comply with the legal framework.

The Environmental History of Cetaceans in Portugal: Ten Centuries of Whale and Dolphin Records

The history between cetaceans and humans is documented throughout time not only in reports, descriptions, and tales but also in legal documents, laws and regulations, and tithes. This wealth of information comes from the easy spotting and identification of individuals due to their large size, surface breathing, and conspicuous above water behaviour. This work is based on historical sources and accounts accounting for cetacean presence for the period between the 12th and 17th centuries, as well as scientific articles, newspapers, illustrations, maps, non-published scientific reports, and other grey literature from the 18th century onwards. Information on whale use in Portugal's mainland has been found since as early as the 12th century and has continued to be created throughout time. No certainty can be given for medieval and earlier events, but both scavenging of stranded whales or use of captured ones may have happened. There is an increasing number of accounts of sighted, stranded, used, or captured cetaceans throughout centuries which is clearly associated with a growing effort towards the study of these animals. Scientific Latin species denominations only started to be registered from the 18th century onwards, as a consequence of the evolution of natural sciences in Portugal and increasing interest from zoologists. After the 19th century, a larger number of observations were recorded, and from the 20th century to the present day, regular scientific records have been collected. Research on the environmental history of cetaceans in Portugal shows a several-centuries-old exploitation of whales and dolphins, as resources mainly for human consumption, followed in later centuries by descriptions of natural history documenting strandings and at sea encounters. Most cetaceans species currently thought to be present in Portuguese mainland waters were at some point historically recorded.

Challenges of converting nonprofit in for-profit-reasons decision making and key success factores of a conversion

Due to external constraints (opposed by the market and legal system) and internal changes nonprofit organizations have been converting to for-profit entities combining commercial revenue and social value creation. To create an understanding of the conversion process considering its challenges, the reasons, the decision-making process and key success factors of a conversion are examined. Therefore, a two-step research procedure is used combining literature research and a multiple case study approach based on expert interviews with known companies. The outcome is a helpful guideline (including a decision matrix) for social entrepreneurs that might face a conversion.

Immune reconstitution inflammatory syndrome in HIV and sporotrichosis coinfection: report of two cases and review of the literature

We report 2 cases of patients with immune reconstitution inflammatory syndrome (IRIS) associated with cutaneous disseminated sporotrichosis and human immunodeficiency virus (HIV) coinfection. The patients received specific treatment for sporotrichosis. However, after 4 and 5 weeks from the beginning of antiretroviral therapy, both patients experienced clinical exacerbation of skin lesions despite increased T CD4+ cells (T cells cluster of differentiation 4 positive) count and decreased viral load. Despite this exacerbation, subsequent mycological examination after systemic corticosteroid administration did not reveal fungal growth. Accordingly, they were diagnosed with IRIS. However, the sudden withdrawal of the corticosteroids resulted in the recurrence of IRIS symptoms. No serious adverse effects could be attributed to prednisone. We recommend corticosteroid treatment for mild-to-moderate cases of IRIS in sporotrichosis and HIV coinfection with close follow-up.

Integrative literature review of the reported uses of serological tests in leprosy management

Abstract: An integrative literature review was conducted to synthesize available publications regarding the potential use of serological tests in leprosy programs. We searched the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Índice Bibliográfico Espanhol em Ciências da Saúde, Acervo da Biblioteca da Organização Pan-Americana da Saúde, Medical Literature Analysis and Retrieval System Online, Hanseníase, National Library of Medicine, Scopus, Ovid, Cinahl, and Web of Science for articles investigating the use of serological tests for antibodies against phenolic glycolipid-I (PGL-I), ML0405, ML2331, leprosy IDRI diagnostic-1 (LID-1), and natural disaccharide octyl-leprosy IDRI diagnostic-1 (NDO-LID). From an initial pool of 3.514 articles, 40 full-length articles fulfilled our inclusion criteria. Based on these papers, we concluded that these antibodies can be used to assist in diagnosing leprosy, detecting neuritis, monitoring therapeutic efficacy, and monitoring household contacts or at-risk populations in leprosy-endemic areas. Thus, available data suggest that serological tests could contribute substantially to leprosy management.

Double pylorus: case report and review of the literature

Double pylorus is an unusual condition in which a double communication between the gastric antrum and the duodenal bulb occurs. It may be congenital, or it may be acquired complication of peptic ulcer disease. We present a case of double pylorus in a gentleman with epigastric pain and previous history of peptic ulcer disease. The relationship between Helicobacter pylori and this disease was assessed. A review of the literature, the role of associated diseases and the role of H. pylori are discussed.

Laparoscopic treatment of retroperitoneal fibrosis: report of two cases and review of the literature

OBJECTIVES: We present the results of treatment by laparoscopy of two patients with retroperitoneal fibrosis and review the literature since 1992, when the first case of this disease that was treated using laparoscopy was published. We also discuss the contemporary alternatives of clinical treatment with corticosteroids and tamoxifen. CASE REPORT: Two female patients, one with idiopathic retroperitoneal fibrosis, and other with retroperitoneal fibrosis associated with Riedel's thyroiditis, were treated using laparoscopic surgery. Both cases had bilateral pelvic ureteral obstruction and were treated using the same technique: transperitoneal laparoscopy, medial mobilization of both colons, liberation of both ureters from the fibrosis, and intraperitonealisation of the ureters. Double-J catheters were inserted before the operations and removed 3 weeks after the procedures. The first patient underwent intraperitonealisation of both ureters in a single procedure. The other had 2 different surgical procedures because of technical difficulties during the first operation. Both patients were followed for more than 1 year and recovered completely from the renal insufficiency. One of them still has occasional vague lumbar pain. There were no abnormalities in the intravenous pyelography in either case. CONCLUSIONS: Surgical correction of retroperitoneal fibrosis, when indicated, should be attempted using laparoscopy. If possible, bilateral ureterolysis and intraperitonealisation of both ureters should be performed in the same operation.