Femoral Approach: an Exceptional Alternative for Permanent Pacemaker Implantation

The classic transvenous implantation of a permanent pacemaker in a pectoral location may be precluded by obstruction of venous access through the superior vena cava or recent infection at the implant site. When these barriers to the procedure are bilateral and there are also contraindications or technical difficulties to performing a thoracotomy for an epicardial approach, the femoral vein, although rarely used, can be a viable alternative. We describe the case of a patient with occlusion of both subclavian veins and a high risk for mini-thoracotomy or videothoracoscopy, who underwent implantation of a permanent single-chamber pacemaker via the right femoral vein.

Effect of surfactant on PDLC films with and without permanent memory effect

Disserta����o para obten����o do Grau de Mestre em Engenharia Qu��mica e Bioqu��mica

Production of chitin-glucan complex by Pichia pastoris

Dissertation for the Degree of Master in Biotechnology

Ruling the Empire: The Portuguese Colonial Office (1820s-1926)

Portugal was one of the first and most enduring European colonial powers of modern times: 1415 and 1975 mark the beginning and the end of a long empire cycle that left impressive imprints in many places. Since it started, the overseas expansion and the exploration of the colonial resources were closely articulated with state-building and the preservation of national independence. A forerunner at the Great Age of Discoveries, but a latecomer in the era of industrialization, in the 19th and early-20th centuries Portugal was a peripheral country, and the economic gap with the rich and industrialized core of Europe was wide. During this period, however, the country faced the critical challenge of ruling vast and geographically scattered overseas territories, and of preserving them from the greed of strong imperialist powers. This article starts by outlining the major developments in the Portuguese colonial policy over a century, since the 1820s until 1926. The independence of Brazil (1822) was a crucial turning point, which brought about a shift towards Africa. The First Republic (1910-1926), pervaded by a nationalist ideology, gave a new impetus to the efforts towards a more effective colonisation. Symptomatically, a Ministry of Colonies was then established for the first time. Second, it describes and analyses the transformation of the central office for colonial affairs ��� from a small ministerial department to an autonomous ministry -, stressing the increasing bureaucratic specialisation, the growth of the apparatus and its staff, and the introduction of new criteria for the selection and promotion of permanent officials (namely a higher profile given to careers in local colonial administration). Finally, it presents a collective biography of both the politicians (Cabinet ministers) and the administrators (directors-general) who ran the Colonial Office for a large period of the Constitutional Monarchy (from 1851 to 1910) and during the First Republic, thus enabling to assess the impact of regime change on elite circulation and career patterns.

The Impact of Bilingualism on Acquiring Second Language Vocabulary: A Case Study

Trabalho de Projecto apresentado para cumprimento dos requisitos necess��rios �� obten��ao do grau de Mestre em Did��ctica do Ingl��s,

Smart windows with permanent memory effect

Disserta����o para obten����o do Grau de Mestre em Engenharia Qu��mica e Bioqu��mica

Utopia III or an Ambiguous Humanist Utopia for the Second Millenium

Portuguese literature does not have many examples of successful and renowned utopias, though the considerable amount of published utopias written in foreign languages and translated to Portuguese language being quite relevant. However, in the last quarter of the twentieth century, almost at the eve of the second millennium an important Portuguese utopia was published: Utopia III, written by Pina Martins (1998). This long novel is structured as being the sequel of More���s Utopia, presenting the history and actual status of the mother of all literary utopias. The question at the basis of the whole novel is, ���What would More���s Utopia be like today?��� The main goal of this text will be to presente a literary analysis of Utopia III, focusing on the humanist principles and their adaptation to contemporary society, the search for a harmonious relationship between city and nature, the defence of a Portuguese identity and the appeal to a humanist renewal.

One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

INTRODUCTION: The septal position is an alternative site for cardiac pacing (CP) that is potentially less harmful to cardiac function. METHODS: Patients with Chagas disease without heart failure submitted to permanent pacemaker (PP) implantation at the Clinics Hospital of the Tri��ngulo Mineiro Federal University (UFTM), were selected from February 2009 to February 2010. The parameters analyzed were ventricular remodeling, the degree of electromechanical dyssynchrony (DEM), exercise time and VO2 max during exercise testing (ET) and functional class (NYHA). Echocardiography was performed 24 to 48h following implantation and after one year follow-up. The patients were submitted to ET one month postprocedure and at the end of one year. RESULTS: Thirty patients were included. Patient mean age was 59��13 years-old. Indication for PP implantation was complete atrioventricular (AV) block in 22 (73.3%) patients and 2nd degree AV block in the other eight (26.7%). All patients were in NYHA I and no changes occurred in the ET parameters. No variations were detected in echocardiographic remodeling measurements. Intraventricular dyssynchrony was observed in 46.6% of cases and interventricular dyssynchrony in 33.3% of patients after one year. CONCLUSIONS: The findings of this work suggest that there is not significant morphological and functional cardiac change following pacemaker implantation in septal position in chagasic patients with normal left ventricular function after one year follow-up. Thus, patients may remain asymptomatic, presenting maintenance of functional capacity and no left ventricular remodeling.

Assessment by doppler ultrasound of entheseal lesions in spondyloarthritis : a longitudial study to determine structural damage and disease activity lesions

RESUMO: Enthesitis is the hallmark of spondyloarthritis (SpA), and is observed in all subtypes. Wide information on SpA abnormalities, including synovitis, tendinitis and enthesitis, can be efficiently perceived by Doppler ultrasound. Furthermore, several studies on imaging of enthesis showed that imaging techniques are better than clinical examination to detect enthesis alterations; and vascularized enthesitis detected by Doppler ultrasound appears to be a valuable diagnostic tool to confirm SpA diagnosis. However, data published until now concerning entheseal elementary alterations that characterize SpA enthesitis (enthesis inflammatory activity) or enthesopathy (permanent structural changes) reflect rather the authors��� empiric opinion than a methodological validation process. In this sense it seems crucial to identify elementary entheseal lesions associated with activity or damage, in order to improve monitoring and treatment response in SpA patients. The development of better assessment tools is today a challenge and a need in SpA. The first study of this thesis focused on the analysis of the reliability of inter-lector and inter-ultrasonography equipment of Madrid sonography enthesitis index (MASEI). Fundamental data for the remaining unrolling project validity. In the second and third studies we concerned about two entheseal elemental lesions: erosions and bursa. In literature erosions represent a permanent structural damage, being useful for monitoring joint injury, disease activity and therapeutic response in many rheumatic diseases; and to date, this concept has been mostly applied in rheumatoid arthritis (RA). Unquestionably, erosion is a tissue-related damage and a structural change. However, the hypothesis that we decided to test was if erosions represent a permanent structural change that can only grow and worsen over time, as occurs in RA, or a transitory alteration. A longitudinal study of early SpA patients was undertaken, and the Achilles enthesis was used as a model. Our results strongly suggested that previously detected erosions could disappear during the course of the disease, being consistent with the dynamic behavior of erosion over time. Based on these striking results it seems reasonable to suggest that the new-bone formation process in SpA could be associated with the resolution of cortical entheseal erosion over time. These results could also be in agreement with the apparent failure of anti-tumor necrosis factor (TNF) therapies to control bone proliferation in SpA; and with the relation of TNF-��, Dickkopf-related protein 1 (Dkk-1) and the regulatory molecule of the Wnt signaling pathway in the bone proliferation in SpA. In the same model, we then proceeded to study the enthesis bursa. Interestingly, the Outcome Measures in Rheumatology Clinical Trials (OMERACT) enthesopathy definition does not include bursa as an elementary entheseal lesion. Nonetheless, bursa was included in 46% of the enthesis studies in a recently systematic literature review, being in agreement with the concept of ���synovio-entheseal complex��� that includes the link between enthesitis and osteitis in SpA. It has been clarified in recent data that there is not only a close functional integration of the enthesis with the neighboring bone, but also a connection between enthesitis and synovitis. Therefore, we tried to assess the prevalence and relevance of the bursa-synovial lesion in SpA. Our findings showed a significant increase of Achilles bursa presence and thickness in SpA patients compared to controls (healthy/mechanical controls and RA controls). These results raise awareness to the need to improve the enthesopathy ultrasonographic definition. In the final work of this thesis, we have explored new perspectives, not previously reported, about construct validity of enthesis ultrasound as a possible activity outcome in SpA. We performed a longitudinal Achilles enthesis ultrasound study in patients with early SpA. Achilles ultrasound examinations were performed at baseline, six- and twelve-month time periods and compared with clinical outcome measures collected at basal visit. Our results showed that basal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are higher in patients with Doppler signal in enthesis, and even that higher basal ESR, CRP and Ankylosing Spondylitis Disease Activity Score (ASDAS) predicted a higher Doppler signal (an ultrasound alteration accepted as representative of inflammation) six months later. Patients with very high disease activity assessed by ASDAS (>3.5) at baseline had significantly higher Achilles total ultrasound score verified at the same time; and ASDAS <1.3 predicted no Doppler signal at six and twelve months. This seems to represent a connection between classical biomarkers and clinical outcomes associated with SpA activity and Doppler signal, not only at the same time, but also for the following months. Remarkably, patients with inactive disease (ASDAS < 1.3) at baseline had no Doppler signal at six and twelve months. These findings reinforce the potential use of ultrasound related techniques for disease progression assessment and prognosis purposes. Intriguingly, Ankylosing Spondylitis Disease Activity Index (BASDAI) didn���t show significant differences between different cut-offs concerning ultrasound lesions or Doppler signal, while verified with ASDAS. These results seem to indicate that ASDAS reflects better than BASDAI what happens in the enthesis. The work herein discussed clearly shows the potential utility of ultrasound in enthesis assessment in SpA patients, and can be important for the development of ultrasound activity and structural damage scores for diagnosis and monitoring purposes. Therefore, local promotion of this technique constitutes a medical intervention that is worth being tested in SpA patients for diagnosis, monitoring and prognosis purposes.

Valorization of agroindustrial waste

The main objective of this work is the valorization of residues from agro-industry giving them an added value. The valorization was performed by using a "green" and sustainable solvent - supercritical fluid, in this case carbon dioxide. Two residues and one biomass were used to produce two different final products, thereby emphasizing the versatility of the waste recovery - spent coffee grounds and microalgae Chlorella protothecoides to produce biodiesel, and tomato pomace to extract carotenoids. In the first part of this work it was demonstrated the possibility to obtain a conversion of coffee spent grounds oil into biodiesel, through an enzymatic transesterification reaction, of 98.01% with the following operating conditions: molar ratio oil:methanol 1:24, residence time 0.8 min, pressure 25 MPa, temperature 313,15K. In this first phase, it was also used the microalgae Chlorella protothecoides, a biomass, to produce biodiesel and favorable results were obtained with this green process compared with a traditional process - basic catalysis / acid. In the second part of this work, by an extraction with supercritical CO2 it was obtained 3.38% oil from tomato pomace under the following conditions: pressure 35.1 MPa, temperature 313,15K. It was found that this oil contains various carotenoids: ��-carotene, lutein and lycopene. The latter is present in larger amount.

Malaria in the State of Amazonas: a typical Brazilian tropical disease influenced by waves of economic development

In Brazil, more than 99% of malaria cases are reported in the Amazon, and the State of Amazonas accounts for 40% of this total. However, the accumulated experience and challenges in controlling malaria in this region in recent decades have not been reported. Throughout the first economic cycle during the rubber boom (1879 to 1912), malaria was recorded in the entire state, with the highest incidence in the villages near the Madeira River in the Southern part of the State of Amazonas. In the 1970s, during the second economic development cycle, the economy turned to the industrial sector and demanded a large labor force, resulting in a large migratory influx to the capital Manaus. Over time, a gradual increase in malaria transmission was observed in peri-urban areas. In the 1990s, the stimulation of agroforestry, particularly fish farming, led to the formation of permanent Anopheline breeding sites and increased malaria in settlements. The estimation of environmental impacts and the planning of measures to mitigate them, as seen in the construction of the Coari-Manaus gas pipeline, proved effective. Considering the changes occurred since the Amsterdam Conference in 1992, disease control has been based on early diagnosis and treatment, but the development of parasites that are resistant to major antimalarial drugs in Brazilian Amazon has posed a new challenge. Despite the decreased lethality and the gradual decrease in the number of malaria cases, disease elimination, which should be associated with government programs for economic development in the region, continues to be a challenge.

O abuso de informa����o privilegiada (insider trading)

In the stock market, information takes on special relevance, due to the market���s permanent updating and the great fluidity of information existent therein. Just as in any other negotiations, the party with the better information has a bargaining advantage, as it is able to make more advantageous business decisions. However, unlike most other markets, the proper functioning of the stock market is greatly dependent on investors��� trust in the market itself. As such, if there are investors who, due to any condition they possess or office they hold, have access to relevant information which is not accessible to the general public, distrust is bred within the market and, consequently, investment is lessened. Thus, there is a need to prevent those who hold privileged information from using it in abusive ways. In Portugal, abuse of privileged information is set out and punished criminally in Article 378. of the Portuguese Securities Code (���C��digo dos Valores Mobili��rios���). In this dissertation, I have set out, firstly, to analyze the inherent conditions for there to be a crime of abuse of privileged information; secondly, to analyze two well-known cases, which took place and were decided in other jurisdictions, and attempt to understand how these cases would fall under Article 378. of the Portuguese Securities Code. Whereas the first case, Chiarella v. United States, was scrutinize under Article 378 of the Portuguese Securities Code, in the second, Lafonta v. AMF, the conclusion arrived at was that the crime taken place was different. This analysis allowed, on one hand, the application to a particular case of prerequisites and concepts which were explained, at a first approach, from a more theoretical perspective; on the other hand, it also allowed the further development of specific aspects of the regime, namely the difference between an insider and a tipee, as well as to more clearly set out the limits to the precise character of the information at hand.

The burden of chronic low back pain in the adult Portuguese population : an epidemiological population-based study under the scope of Epireumapt

RESUMO: Nos pa��ses desenvolvidos a lombalgia �� a condi����o m��sculo-�����esquel��tica mais prevalente. Quando evolui para um quadro cr��nico �� respons��vel por um encargo econ��mico bastante consider��vel, n��o s�� em rela����o aos indiv��duos, mas tamb��m para a sociedade. A lombalgia cr��nica �� por isso uma das principais causas de perda de produtividade e de perda de independ��ncia econ��mica, nomeadamente atrav��s do absente��smo (aus��ncia do trabalho), do presente��smo (perda de produtividade no trabalho, devido �� capacidade diminu��da provocada pela lombalgia) e da incapacidade para trabalhar (invalidez permanente, total ou parcial). At�� �� data, em Portugal, a preval��ncia e carga social da lombalgia cr��nica eram desconhecidas. At�� agora n��o existiam estudos populacionais de grande dimens��o sobre este tema. O objetivo principal desta tese foi determinar a preval��ncia de lombalgia cr��nica, e tamb��m avaliar a carga social que esta tem na popula����o adulta Portuguesa. O trabalho de investiga����o foi desenvolvido no ��mbito do Estudo Epidemiol��gico de Doen��as Reum��ticas em Portugal (EpiReumaPt). Este foi o primeiro estudo de larga escala e de base populacional, que determinou a preval��ncia de doen��as reum��ticas e m��sculo-����� esquel��ticas na popula����o adulta portuguesa. Foi realizado numa amostra aleat��ria e representativa, de 10.661 indiv��duos do Continente, da Regi��o Aut��noma dos A��ores e da Regi��o Aut��noma da Madeira, entre Setembro de 2011 e Dezembro de 2013. Esta tese foi dividida em duas sec����es. A primeira sec����o incluiu o detalhe das quest��es relativas ao desenvolvimento e gest��o do EpiReumaPt, constituindo-�����se como um guia pr��tico sobre como realizar um estudo de base populacional de larga escala, em Portugal. A metodologia detalhada do EpiReumaPt foi tamb��m descrita nesta sec����o e incluiu os objectivos, o desenho do estudo, as caracter��sticas de recrutamento e a prepara����o de dados para an��lise. Nesta sec����o foram ainda descritos os principais resultados do EpiReumaPt. Estes evidenciaram que a lombalgia foi a condi����o m��sculo-�����esquel��tica com maior preval��ncia na popula����o adulta portuguesa.A segunda sec����o desta tese estimou a preval��ncia da lombalgia cr��nica ativa na popula����o adulta Portuguesa, e avaliou a carga social esta condi����o. A lombalgia ativa foi definida com base na dor auto-�����relatada no dia da entrevista e que persistia h�� pelo menos 90 dias (independentemente da causa). A lombalgia foi definida como dor na ��rea definida entre a margem inferior das d��cimas segundas costelas at�� ��s pregas gl��teas inferiores, com ou sem dor nos membros inferiores. A carga social foi medida tendo em conta os seguintes par��metros: qualidade de vida, fun����o, consumo de recursos de sa��de, consumo de analg��sicos e outros f��rmacos usados no al��vio da dor, sintomas de ansiedade e sintomas de depress��o. Os resultados mostraram que o consumo de recursos em sa��de e a carga social da lombalgia cr��nica na popula����o adulta Portugu��s �� significativa. Tamb��m a incapacidade causada pela lombalgia cr��nica,nos indiv��duos com idade ativa, �� respons��vel por elevadas taxas de absente��smo e m�� qualidade de vida, aos quais acresce o consequente ��nus socioecon��mico. Esta tese tamb��m concluiu que o consumo de analg��sicos e outros medicamentos para al��vio da dor, na popula����o adulta portuguesa com lombalgia cr��nica ativa, �� relativamente baixa. A maioria destes indiv��duos n��o tomava nenhum medicamento analg��sico, independentemente da intensidade da dor. Mesmo os indiv��duos que reportaram dor intensa, apenas 4.0% estavam no primeiro degrau da escada analg��sica da Organiza����o Mundial de Sa��de; 2.3% usavam opi��ides fracos e 0.03% usavam opi��ides fortes para controlar a dor (segundo e terceiro degrau da escada analg��sica da Organiza����o Mundial da Sa��de). O trabalho de investiga����o tamb��m confirmou que a preval��ncia de sintomas de ansiedade e depress��o entre os indiv��duos adultos portugueses com lombalgia cr��nica ativa �� elevada. Nestes indiv��duos, registou-�����se um consumo mais elevado de analg��sicos e outros medicamentos para al��vio da dor, quando comparados com os indiv��duos com lombalgia cr��nica activa sem esses sintomas psicol��gicos. Os grupos terap��uticos mais utilizados foram os ansiol��ticos, sedativos e hipn��ticos, os antidepressivos e os anti-�����inflamat��rios n��o ester��ides. A intensidade m��dia da dor reportada foi tamb��m maior entre os indiv��duos com lombalgia ativa e sintomas de ansiedade e/ou depress��o. Tamb��m nestes, foi reportada pior fun����o e pior estado de sa��de. Em rela����o ao consumo de recursos de sa��de foram encontradas diferen��as significativas entre as duas popula����es: os indiv��duos com lombalgia ativa e sintomas psicol��gicos concomitantes registaram maior n��mero de consultas de psiquiatria de outras especialidades m��dicas, assim como precisaram de mais apoio domicili��rio nos 12 meses pr��vios �� entrevista do EpiReumaPt. Foram tamb��m identificados os fatores associados a sintomas isolados de ansiedade, a sintomas isolados de depress��o e a sintomas de ansiedade e depress��o. Resumindo,esta tese permitiu concluir que a lombalgia cr��nica �� um problema de sa��de comum na popula����o adulta portuguesa, contribuindo para um elevado grau de incapacidade e que consequentemente afeta o desempenho laboral e o bem-�����estar dos indiv��duos. A lombalgia cr��nica �� tamb��m respons��vel por um consumo consider��vel de recursos de sa��de. Acresce ainda que os sintomas de ansiedade e depress��o s��o comuns, entre os indiv��duos com lombalgia cr��nica, contribuindo com uma carga social adicional.---------------------------------- ABSTRACT:Low Back Pain(LBP) is the most prevalent of musculoskeletal condition in developed countries.When it becomes chronic, LBP causesan enormous economic burden on individuals and society -����� it is one of the leading causes of loss of productivity and economic independence through absenteeism (time off work), presenteeism (lost productivity because of diminished capacity while at work) and work disability (permanent, partial or complete disablement for work purposes). In Portugal the prevalence and burden of LBP and chronic LBP (CLBP) were poorly defined. Until now no large population-�����based studies have focused on this. The main aim of this thesis was to determine the prevalence of LBP and CLBP, and also to assess the burden of CLBP in the adult rtuguese population. The research work was developed under the scope of EpiReumaPt (the Portuguese Epidemiologic Study of Rheumatic Diseases). EpiReumaPt was the first national large population-�����based and prevalence study of rheumatic and musculoskeletal diseases (RMD). It was performed among a randomized and representative sample of 10,661 adult Portuguese subjects recruited in Mainland, Azores and Madeira Islands, from September 2011 to December 2013. The first section of this thesis included detailed issues regarding the development and management of EpiReumaPt, and provided a practical guide on how to set-�����up a large population-�����based study in Portugal. The detailed methodology of EpiReumaPt, including its objectives,study design,recruitment features,and data preparation for analyses were also described. The main results from EpiReumaPt study were provided in this section and showed that LBP was the musculoskeletal condition with highest prevalence among Portuguese population. The second section of this thesis estimated the prevalence of active CLBP among adult Portuguese population, and assessed the social burden of this condition. Active CLBP was defined based on self-�����reported pain on the day of the interview, and for most of the time for at least 90 days (independently from cause). LBP was defined as pain in the back area from the lower margin of the twelfth ribs to he lower gluteal folds, with or without pain referred to the lower limbs. Social burden was measured taking into account the following outcomes: quality of life, function, healthcare resources consumption, analgesic and other pain relief drugs intake, anxiety and depression symptoms. Results showed that the healthcare consumption and social burden of CLBP among adult Portuguese population were enormous, and the disability caused by CLBP among subjects in a working age provides high rates of absenteeism (work loss) and poor quality of life, with a consequent socioeconomic burden. This thesis also concluded that analgesic and other pain relief drugs untake among adult Portuguese population with active CLBP was very low. Most of the subjects with active CLBP did not take any analgesic drug regardless pain severity. Even when subjects self-�����reported severe pain, only 24.0% were in the 1st step of the analgesic ladder,2.3% used weak analgesic opioids and 0.03% used strong opioids (2nd and 3rd step of WHO analgesic ladder, respectively) to control pain . The research work also confirmed that the prevalence of anxiety and depression symptoms among adult Portuguese subjects with active CLBP was high. Regarding pharmacological therapy, the intake of analgesic and other pain relief drugs was higher among subjects with anxiety and/or depression symptoms, when compared with subjects without these psychological symptoms. Anxiolytics, sedatives and hypnotics, antidepressants and NSAIDs intake had higher usage rates among these subjects. The pain severity mean was also higher among this subjects and function and health status was worse. Regarding healthcare resources consumption,significant differences between the two populations were found. Subjects with ctive CLBP and concomitant psychological symptoms had a higher number of psychiatrist and other physician visits. They also needed more home care in the previous 12 months. Factors associated with isolated symptoms of anxiety, depression,and concomitant anxiety and depression symptoms were also identified. Summarizing, we concluded that CLBP is a common health problem among adult Portuguese population contributing to disability and affecting labor performance, and the well being of subjects. it is also responsible for considerable healthcare resource consumption. Anxiety and depression symptoms are common among subjects with CLBP and provided an additional burden among them.