Marine Cyanobacteria Compounds with Anticancer Properties: Implication of Apoptosis

Marine cyanobacteria have been proved to be an important source of potential anticancer drugs. Although several compounds were found to be cytotoxic to cancer cells in culture, the pathways by which cells are affected are still poorly elucidated. For some compounds, cancer cell death was attributed to an implication of apoptosis through morphological apoptotic features, implication of caspases and proteins of the Bcl-2 family, and other mechanisms such as interference with microtubules dynamics, cell cycle arrest and inhibition of proteases other than caspases.

Is It Possible to Simplify Risk Stratification Scores for Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty?

INTRODUCTION: There are several risk scores for stratification of patients with ST-segment elevation myocardial infarction (STEMI), the most widely used of which are the TIMI and GRACE scores. However, these are complex and require several variables. The aim of this study was to obtain a reduced model with fewer variables and similar predictive and discriminative ability. METHODS: We studied 607 patients (age 62 years, SD=13; 76% male) who were admitted with STEMI and underwent successful primary angioplasty. Our endpoints were all-cause in-hospital and 30-day mortality. Considering all variables from the TIMI and GRACE risk scores, multivariate logistic regression models were fitted to the data to identify the variables that best predicted death. RESULTS: Compared to the TIMI score, the GRACE score had better predictive and discriminative performance for in-hospital mortality, with similar results for 30-day mortality. After data modeling, the variables with highest predictive ability were age, serum creatinine, heart failure and the occurrence of cardiac arrest. The new predictive model was compared with the GRACE risk score, after internal validation using 10-fold cross validation. A similar discriminative performance was obtained and some improvement was achieved in estimates of probabilities of death (increased for patients who died and decreased for those who did not). CONCLUSION: It is possible to simplify risk stratification scores for STEMI and primary angioplasty using only four variables (age, serum creatinine, heart failure and cardiac arrest). This simplified model maintained a good predictive and discriminative performance for short-term mortality.

Financiamento hospitalar em Portugal : incentivos à selecção e equidade

RESUMO - Contexto: O sistema de financiamento do internamento hospitalar público Português é de natureza prospectiva, através de um orçamento global baseado no casemix para os doentes do Serviço Nacional de Saúde (SNS) e de um pagamento por episódio para os doentes dos subsistemas. Em ambos os casos, o financiamento baseia-se principalmente nos Grupos de Diagnóstico Homogéneos (GDH) correspondentes a cada episódio, seja para atribuir um preço por doente saído no caso dos doentes dos subsistemas, seja para calcular o casemix do hospital no caso dos doentes do SNS. Atendendo à heterogeneidade de utilização de recursos intra GDH, resultante das características e necessidades individuais de cada doente, é expectável que o hospital, tendo em vista a garantia da sustentabilidade económica e financeira e/ou a obtenção de mais-valias, procure que o custo de produção fique aquém do preço médio pago, o que pode resultar na selecção de doentes. Por outro lado, ao não ser tida em conta no financiamento, e na ausência de selecção, a heterogeneidade intra GDH pode resultar na injusta recompensa/penalização de uns hospitais em detrimento de outros, tendo em conta as características e necessidades da população que servem e pelas quais não são compensados. Objectivos: O presente estudo propôs-se, por isso, avaliar o impacte que as características inerentes aos doentes têm no consumo de recursos hospitalares, tendo em vista inferir se as mesmas criam incentivos à selecção de doentes ou são fonte de penalizações ou recompensas injustas para os hospitais. Metodologia: Foi utilizada a amostra completa dos doentes internados no ano 2007 por doenças e perturbações do aparelho circulatório (Grande Categoria de Diagnóstico 5) nos 76 hospitais públicos Portugueses (69.905 episódios). Assumiu-se como proxy dos custos a variável tempo de internamento, e avaliou-se, mediante a realização de uma regressão linear multivariada, a relação existente entre a variação no tempo de internamento e as características sexo, idade, severidade, comorbilidades e estatuto económico dos doentes, tendo-se concluído que todas, menos o sexo, têm impacte significativo no tempo de internamento. Uma análise preliminar da distribuição das características identificadas como indutoras de custos pelos hospitais em estudo, conforme o resultado financeiro alcançado por estes fosse positivo ou negativo, sugeriu que as mesmas podem ter impacte nos resultados financeiros alcançados pelos hospitais. Conclusão: Concluiu-se que a actual metodologia de financiamento dos hospitais públicos portugueses possui incentivos à selecção de doentes, visto possibilitar a identificação de doentes que pelas suas características se tornam menos “rentáveis” para os hospitais, o que se pode traduzir numa perda de qualidade assistencial e de acessibilidade para os mesmos e beneficia/penaliza uns hospitais em detrimento de outros, de acordo com as características da população que servem.

Aortic and Tricuspid Endocarditis in Hemodialysis Patient with Systemic and Pulmonary Embolism

This is a case report of a 43-year-old Caucasian male with end-stage renal disease being treated with hemodialysis and infective endocarditis in the aortic and tricuspid valves. The clinical presentation was dominated by neurologic impairment with cerebral embolism and hemorrhagic components. A thoracoabdominal computerized tomography scan revealed septic pulmonary embolus. The patient underwent empirical antibiotherapy with ceftriaxone, gentamicin and vancomycin, and the therapy was changed to flucloxacilin and gentamicin after the isolation of S. aureus in blood cultures. The multidisciplinary team determined that the patient should undergo valve replacement after the stabilization of the intracranial hemorrhage; however, on the 8th day of hospitalization, the patient entered cardiac arrest due to a massive septic pulmonary embolism and died. Despite the risk of aggravation of the hemorrhagic cerebral lesion, early surgical intervention should be considered in high-risk patients.

Miocardiopatia Periparto. Paragem Cardiorespiratória Pós-Parto Complicada por Acretismo Placentar

Peripartum cardiomiopathy is a rare and life-threatening cardiac disease that affects young women previously healthy, during the peripartum period. It is a form of dilated cardiomyopathy with left-sided systolic dysfunction, which may lead to symptoms and signs of congestive heart failure. The exclusion diagnosis is based essentially on clinical presentation and initial symptoms may mimic physiologic alterations of pregnancy. The authors present a case of a 34 week multiple gestation with a growth restriction of one of the fetus and with a suspicion of a mild pre-eclampsia, motive by which we decided labour induction. During placental expulsion, in which we noticed difficulty in finding placental cleavage, the patient presented an assistoly, recovering after cardiorespiratory reanimation. However, the profuse bleeding after labour leaded to a life saving hysterectomy. Histological examination revealed placenta accreta. The echocardiography performed post-operatively diagnosed a dilated cardiomyopathy.

Sudden sensorineural hearing loss : evaluation of co-morbidities and potential clinical associations

RESUMO: A surdez súbita (SS) caracteriza-se por uma perda abrupta de audição, mais frequentemente unilateral e associada a sensação de preenchimento aural, acufenos e vertigem. Afecta 5-20/100.000pessoas/ano (sobretudo adultos em fase activa na década de 40), com grande impacto na qualidade de vida. Possíveis causas incluem doenças infecciosas, circulatórias, traumáticas, imunológicas, neoplásicas, neurológicas, tóxicas e cocleares. No entanto, a causa da SS permanece desconhecida na maioria dos casos (80%), o que origina tratamentos controversos e frequentemente ineficientes. Os tratamentos disponíveis variam desde corticosteróides a antivirais, vasodilatadores, anti-agregantes, anticoagulantes, vitaminas e oxigénio hiperbárico (OHB). Atendendo a falta de informação relativa à etiologia e fisiopatologia da SS, pretendemos avaliar a evolução clínica dos doentes com SS tratados com OHB no Centro de Medicina Subaquática e Hiperbárica (CMSH) de Lisboa entre 2000 e 2005, durante um período mínimo de 5 anos, na tentativa de identificar eventuais factores de risco ou noxas clínicas com a SS. O estudo retrospectivo proposto baseia-se na revisão de processos clínicos do CMSH e na aplicação telefónica de questionários médicos de “follow-up” confidenciais – tanto a doentes (grupo de estudo), como aos respectivos esposos/companheiros/membros próximos da família (grupo de controlo) –, com particular ênfase nos antecedentes médicos e história clínica actual. Um estudo preliminar de 20 pessoas (10 doentes e 10 controlos) foi efectuado para antecipar dificuldades e estimar as necessidades logísticas. As dificuldades identificadas foram: 1) selecção dos doentes com números de telefone válidos e processos clínicos completos (com audiograma inicial e final); 2) contacto telefónico com os participantes de ambos os grupos (de estudo e controlo); 3) recursos humanos requeridos. Dado que a SS não é uma doença em si, mas um sintoma de uma doença subjacente, acreditamos que este estudo epidemiológico seja importante e útil, capaz de gerar novas luzes sobre a fisiopatologia e mecanismos desta entidade clínica.-------------ABSTRACT:Sudden sensorineural hearing loss (SSHL) is characterized by abrupt, mostly unilateral loss of hearing, frequently associated to aural fullness, tinnitus and vertigo. It affects 5-20/100.000 people/year (particularly working adults in the 40ths), with huge impact on quality of life. Possible causes include infectious, circulatory, traumatic, immunologic, metabolic, neoplastic, neurologic, toxic and unidentified cochlear diseases. Nevertheless, SSHL’s etiology remains unknown in most cases (80%), giving rise to controversial (and frequently ineffective) treatments. Available therapies range from corticosteroids to antivirals, vasodilators, antiaggregants, anticoagulants, vitamins and hyperbaric oxygen (HBO). Given the lack of data concerning SSHL’s etiology and physiopathology, we intend to evaluate clinical evolution of such patients treated with HBO in the Underwater and Hyperbaric Medical Center (UHMC) at Lisbon from 2000 to 2005 during a minimum period of 5 years, in an attempt to identify eventual risk factors or clinical associations to SSHL. The intended retrospective study is based on the review of patients’ medical charts from UHMC and confidential follow-up questionnaires applied telephonically both to patients (study group) and patients’ spouse/partner/close family member (control group), focusing past and present medical history. A preliminary study of 20 subjects (10 of each group) was performed to anticipate difficulties and to estimate the required logistics. The identified difficulties were: 1) selection of subjects with valid phone numbers and complete medical charts (with initial and final audiograms); 2) telephonic contact with subjects from the study and control group; 3) human logistics required. As it is believed that SSHL is not a disease by itself but rather a symptom of an underlying disease, we believe that this epidemiologic study is important and will hopefully generate sound scientific knowledge concerning physiopathology and mechanism of disease of SSHL.

Evaluation of chemotherapeutic potential of natural extracts using 3D models of colon cancer

Dissertation to obtain master degree in Biotechnology

Regulation and function of the cell wall polymer lipoteichoic acid in staphylococcus aureus

A thesis submitted for the Degree of Master in Medical microbiology

Clinical and laboratory findings related to a favorable evolution of hantavirus pulmonary syndrome

The medical records of 27 patients with hantavirus pulmonary syndrome were analyzed according to the need for invasive mechanical ventilation in relation to the following data up on hospital admission: age, gender, fever, cough, dyspnea, systolic arterial blood pressure, heart rate, levels of hemoglobin, hematocrit, leukocytes, lymphocytes, platelets, creatinine and arterial blood gases. The volume infused during the first 24 hours after admission, the use of inotropic agents, the use of corticosteroids and the patient outcomes were also evaluated. A favorable outcome was related to systolic blood pressure³ 100mmHg, heart rate lower than 100 beats per minute, creatinine below 1.6mg/dl, arterial blood pH³ 7.35, bicarbonate higher than 15mEq/dl, oxygen saturation higher than 84.1%, lower rehydration volume in the first 24 hours of hospitalization and no use of inotropic agents. Absence of clinical and laboratory signs of circulatory shock up on admission was associated with a favorable outcome of the patients.

Malnutrição em idosos na admissão hospital actuação perante a sua elevado prevalência

RESUMO: Ao longo das últimas décadas a redistribuição etária da população mundial tem vindo a apresentar um aumento do número de pessoas com 65 ou mais anos, integrando um grupo populacional comummente designado por população idosa. Importa aprofundar mecanismos fisiológicos que conduzem ao envelhecimento e de que forma podem condicionar não só aspetos clínicos, como também nutricionais, entre outros, com a perspetiva da sua origem no aparecimento de doenças crónicas. Com esse enfoque, a desnutrição na pessoa idosa é hoje considerada pela European Nutrition for Health Alliance(ENHA) um problema de saúde pública. Está descrito que a sua prevalência ronda os 60% a nível de instituições hospitalares, 40% em unidades residenciais e 5 a 10% na pessoa idosa a residir em domicílio próprio ou de familiares, e na sua maioria permanece por diagnosticar e tratar. Assim, foi objetivo deste estudo caracterizar e estimar a prevalência da desnutrição e do risco de desnutrição na pessoa idosa, nas primeiras 72 horas de admissão hospitalar. Aplicou-se um estudo observacional, analítico, transversal, quantitativo e correlacional, cujos dados foram recolhidos por entrevista ao próprio e por observação. O estudo desenvolveu-se em duas vertentes de investigação, uma focada na caracterização da desnutrição em pessoas idosas institucionalizadas em hospitais portugueses da zona centro e sul do Continente e Madeira, nos períodos de julho/agosto de 2009, abril/junho de 2010, maio/julho de 2011, através do MNA®. A outra, uma avaliação nutricional detalhada, efetuada no Centro Hospitalar de Lisboa Central – Hospital de Santa Marta, EPE, entre o início de janeiro de 2009 e o fim de janeiro de 2010, sendo a amostra recrutada de entre os idosos de ambos os sexos, internados. Foram estudados dados sociodemográficos, de saúde e feita uma avaliação nutricional extensa. A avaliação nutricional constou de colheita de parâmetros laboratoriais (hematológicos e bioquímicos) e antropométricos (índice de massa corporal (IMC), prega cutânea tricipital(PCT), prega cutânea subescapular (PCSE), perímetro braquial (PB), adequação do perímetro braquial (APB), área muscular braquial (AMB) e perímetro Geminal (PG), análise da composição corporal (Massa Gorda Corporal (MGC), Massa Isenta de Gordura (MIG)),caracterização de um dia alimentar tipo e questionário Mini Nutritional Assessment Long Form®– MNA LF®. Dos dados obtidos em hospitais portugueses, destaca-se que dos 402 idosos avaliados, 53% eram do sexo masculino, tinham uma idade média de 75,8 + 6,52 (65 – 100) e segundo o MNA® 57,5% encontravam-se Desnutridos ou em Risco de Desnutrição.Na amostra, dos dados obtidos, a nível sociodemográfico salienta-se que 50% dos doentes eram do sexo masculino, a idade média rondava os 75,5 + 7,22 (65 – 100) anos, 55% eram naturais de Lisboa e 80% residiam em Lisboa e Vale do Tejo, 38% não tiveram estudos formais e 43% fizeram-no apenas até ao 4º ano de escolaridade. Em relação aos dados de saúde, a maioria dos doentes foi admitida através do Serviço de Urgência do Centro Hospitalar de Lisboa Central – Hospital de São José e foram internados no Serviço de Medicina (38%) e no Serviço de Cardiologia (30%), por patologia médica (38%) e patologia do sistema circulatório (56%). Nos hábitos de vida, quanto à mobilidade, um terço dos doentes estavam acamados e os restantes deambulavam ou tinham uma mobilidade normal, 74% não apresentaram hábitos etanólicos regulares, 19% apresentavam um consumo elevado (> 30g de etanol/dia); 95% dos doentes não apresentavam hábitos tabágicos. Relativamente à caracterização nutricional, os valores médios encontrados em relação aos parâmetros laboratoriais revelaram-se inferiores aos valores padrão para a idade e sexo e eram inferiores no sexo feminino. Na caracterização antropométrica verificaram-se os seguintes achados: o cálculo do IMC mostrou-se pouco sensível na identificação de doentes desnutridos; a PCT e a PCSE revelaram valores de massa gorda dentro do intervalo considerado normal;segundo o PB, 88% não apresentavam valor indicativo de desnutrição e 8% estavam desnutridos; a APB identificou 50% de doentes desnutridos; a AMB, revelou que 97% dos homens e 95% das mulheres apresentavam deficit da massa magra e segundo o PG, 18% apresentavam um valor inferior a 31cm descritor de desnutrição. Na análise da composição corporal verificou-se que ambos os sexos apresentavam uma percentagem de MGC classificada como demasiado alta e que esta era superior nas mulheres em relação aos homens. Ao analisar a ingestão nutricional verificou-se que esta era inferior às Dietary Reference Intakes (DRIs) para a ingestão hídrica (p=0,00), energética (p=0,00), proteica (p=0,00), lipídica (p=0,01), MUFA (p=0,00), PUFA (p=0,00), e glícidos (p=0,00), fibra (p=0,02), potássio (p=0,00), cálcio (p=0,00), magnésio (p=0,00), fósforo (p=0,00), zinco (p=0,00), vitamina D (p=0,00), vitamina E (p=0,00) e folato (p=0,00). No que diz respeito ao MNA®, a sua aplicação permitiu identificar 62% de situações de risco nutricional ou de desnutrição já instalada. Valores de MNA® indicativos de desnutrição ou risco estavam associados a níveis de escolaridade mais baixos (r=0,32; p=0,00). Verificou-se correlação entre o MNA® e a PCT (r=0,30;p=0,00), PCSE (r=0,19;p=0,03) e PG (r=0,27;p=0,00). Na análise da amostra por sexo e escalão etário, apenas se distinguiram as mulheres mais velhas, que apresentaram situação de IMC indicador de risco de desnutrição (IMC <23,5 + 2,9, (r=0,42;p=0,02)), e de valores médios de PB de 25,6+3,84cm (r=0,42;p=0,01), em situações de menor mobilidade caraterizados pelo MNA®. Os homens maisvelhos apresentaram correlação entre o MNA® e PCSE (r=0,41;p=0,02), APMB (r=0,57;p=0,00)e PG (r=0,55;p=0,00), e as mulheres mais velhas apenas com a PCT (r=0,39;p=0,02). A análise multivariada do MNA® em função do sexo e do escalão etário, revelou que estes são independentes. Os homens apresentaram valores médios de MNA® superiores às mulheres e à medida que a idade aumenta, os valores de MNA® em ambos os sexos diminuem, sendo indicativos de risco de desnutrição. Consideramos que, tendo em conta a natureza e objetivos do presente estudo, foi possível caracterizar e estimar a prevalência da desnutrição e do risco de desnutrição em pessoas idosas nas primeiras 72 horas de admissão hospitalar. Os resultados obtidos sinalizam a sua elevada prevalência e alertam para a necessidade de procedimentos protocolados de avaliação e intervenção nutricional da população idosa na admissão hospitalar. Para este efeito a aplicação do MNA® provou a sua aplicabilidade, assim como a medição e cálculo da AMB, que poderão ser muito precocemente aplicados e contribuir para potenciar melhorias do estado de saúde e diminuir o tempo de internamento, nomeadamente de pessoas idosas. Em relação ao padrão alimentar, este estudo contribuiu para uma chamada de atenção dos profissionais de saúde que a população idosa pode apresentar carências nutricionais na admissão, e que estas se não forem devidamente sinalizadas e colmatadas tendem a agravar-se durante o internamento podendo contribuir para o aumento da morbilidade.-------------ABSTRACT:Over the last decades the age redistribution group of the population worldwide has been presenting an increasing number of people aged 65 years or more, incorporating a population group commonly referred to as the elderly population. It´s important to further analyze the physiological mechanisms that lead to aging and how they might influence not only clinical aspects, but also nutritional, among others, with the perspective of their origin in the onset of chronic diseases. With this approach, malnutrition in the elderly is now considered by the European Nutrition for Health Alliance (ENHA) a public health problem. It is reported that its prevalence is around 60% at the level of hospital units, 40% in residential units and 5 to 10% in the elderly living in their own home or family's, and mostly remains to diagnose and treat. The aim of this study was to characterize and estimate the prevalence of malnutrition and risk of malnutrition in the elderly, in the first 72 hours of hospital admission. We applied an observational, analytical, cross-sectional and correlacional quantitative type of study and data were collected by interview and observation itself. The study was developed in two lines of research: one focused on the characterization of malnutrition in elderly institutionalized in Portuguese hospitals, in the central and southern mainland and Madeira, in the periods between July - August 2009, April - June 2010, May - July 2011, through the MNA®; and the other: a detailed nutritional assessment, conducted in Hospital Lisbon Center - Hospital de Santa Marta, EPE, between early January 2009 and late January 2010, and the sample was recruited from among the elderly of both sexes at hospital admission. We studied intensively sociodemographic, health and nutritional assessment done extensive. Nutritional evaluation consisted of harvesting different parameters: hematological, biochemical and anthropometric (body mass index (BMI), triceps skinfold (TSF), sub-scapular skinfold (SSF), arm circumference (AC), arm muscle area (AMA), geminal perimeter (GP), analysis of body composition (Fat Mass (FM), Fat Free Mass (FFM)), characterization of a daily food type and Mini Nutritional Assessment Long Form® questionnaire - MNA LF®. Form the data obtained in Portuguese hospitals, it is noteworthy that of the 402 patients included, 53% were male, had a mean age of 75,8 + 6,52 (65 - 100) and, according to the MNA®, 57,5% were malnourished or at risk of malnutrition. In the sample, from the sociodemographic data obtained, we saw that 50% of patients were male, the average age was around 75,5 + 7,22 years (65-100), 55% were from Lisbon and 80 %lived in Lisbon, 38% had no formal education and 43% did so only until the 4th grade. Regarding health data, the majorities of patients were admitted through the ER of Hospital Lisbon Center - S. José Hospital - and were admitted to the Medicine Unit (38%) and to the Cardiology Unit (30%), by medical pathology (38%) and circulatory system disease (56%). In regard to lifestyle, and considering mobility, one third of patients were bedridden and the rest were ambulating or had a normal mobility. 74% had no regular ethanol habits, 19% had a high intake (> 30 g ethanol / day); 95% of the patients had no smoking habits. Regarding nutritional assessment, the mean values for laboratory parameters proved inferior to standard values for age and sex and were lower in females. In anthropometric assessment these were the findings: BMI calculation showed to be scarcely sensitive in the identification of undernourished patients; the TSF and SSF revealed values of fat mass within the normal range; in AC, 88% did not have an indicative value of malnutrition and 8% were malnourished; in AMA, 97% of men and 95% women had a deficit of lean mass and in GP, 18% had a value of less than the 31cm malnutrition descriptor. In body composition analysis found that both sexes showed a percentage of FM ranked too high and this was higher in women compared to men. By analyzing the nutritional intake was found that this was less than the Dietary Reference Intakes (DRIs) for water intake (p=0,00), energy (p=0,00), protein (p=0,00), lipid (p=0,01), MUFA (p=0,00), PUFA (p=0,00), carbohydrates (p=0,00), fiber (p=0,02), potassium (p=0,00), calcium (p=0,00), magnesium (p=0,00), phosphorus (p=0,00), zinc (p=0,00), vitamin D (p=0,00), vitamin E (p=0,00) and folate (p=0,00). Regarding MNA®, its application identified 62% of cases of nutritional risk or malnutrition already installed. MNA® values indicative of malnutrition or risk were associated with lower levels of education (r=0,32; p=0,00). There was a correlation between the MNA ® and TSF (r =0,30, p = 0,00), SFF (r = 0,19, p = 0,03) and GP (r=0,27, p = 0,00). In the analysis of the sample by gender and age group, the highlight was in older women who had BMI status indicator of malnutrition risk (BMI <23,5 + 2,9 (r=0,42;p=0,02)) and mean values of AC 25,6 +3,84cm (r=0,42; p=0,01), in situations characterized by low mobility MNA®. Older men showed a correlation between the MNA® and SFF (r = 0,41; p = 0,02), AMA (r = 0,57; p = 0,00) and GP (r=0,55;p=0,00), and in older women only TSF showed a correlation(r = 0,39; p =0,02). Multivariate analysis of the MNA® by gender and age group, revealed that they are independent. The men had MNA® mean superior to women, and as the age increases, the values of MNA® in both sexes declined, being indicative of risk of malnutrition. We believe that, given the nature and objectives of the present study, it allowed us to characterize and estimate the prevalence of risk of malnutrition and malnutrition in older people during the first 72 hours of hospital admission. The results indicate a high prevalence and point to the need for protocol procedures of nutritional assessment and intervention in the elderly population at hospital admission. For this purpose the application of MNA® has proved its applicability, as well as measuring and calculating AMA, which may be applied in early stages thus contributing to enhance health state improvements and to shorten the time of hospitalization, particularly in elderly people. In relation to dietary pattern, this study contributed to call of attention from health professionals that the elderly may have nutritional deficiencies on admission, and that these are not properly marked and addressed tend to worsen during hospitalization may contribute to increased morbidity.

A abolição da dupla incriminação no mandado de detenção europeu

This essay presents the European Arrest Warrant and its relationship with the principle of double criminality, which was abolished in 2002 with the new Framework Decision (FD). This instrument was essential to implement the principle of mutual recognition and strengthen the police and judicial cooperation in criminal matters in the newly created space of freedom, security and justice. It was urgent to create mechanisms to combat cross-border crime, that alone States have struggled to counter. An analysis of the FD No 2002/584/JHA is made. The execution of warrants and the non-mandatory and optional grounds of refusal are studied in detail. As it is the implementation issue. The role of mutual recognition in practice is studied as well. The procedure is to introduce the principle of double criminality, to explain the concept and its abolition, warning for the consequences derived from them, related to the principle of legality and fundamental rights. The analysis of the European Arrest Warrant in practice in Portugal and in comparison with other Member States allows the measurement of the consequences from the abolition of dual criminality and the position of States on this measure. With the abolition of double criminality, the cooperation in judicial and criminal matters departs from what was intended by the European Council of Tampere. And without cooperation, fundamental rights of citizens are unprotected, so the states have to adopt measures to remedy the "failures" of the European Law.

Features to validate cerebral toxoplasmosis

Introduction Neurotoxoplasmosis (NT) sometimes manifests unusual characteristics. Methods We analyzed 85 patients with NT and AIDS according to clinical, cerebrospinal fluid, cranial magnetic resonance, and polymerase chain reaction (PCR) characteristics. Results In 8.5%, focal neurological deficits were absent and 16.4% had single cerebral lesions. Increased sensitivity of PCR for Toxoplasma gondii DNA in the central nervous system was associated with pleocytosis and presence of >4 encephalic lesions. Conclusions Patients with NT may present without focal neurological deficit and NT may occur with presence of a single cerebral lesion. Greater numbers of lesions and greater cellularity in cerebrospinal fluid improve the sensitivity of PCR to T gondii.

Essays in health economics: Volume-Outcome Effect, upcoding behaviour and the evaluation of a short-term intervention program

Evidence in the literature suggests a negative relationship between volume of medical procedures and mortality rates in the health care sector. In general, high-volume hospitals appear to achieve lower mortality rates, although considerable variation exists. However, most studies focus on US hospitals, which face different incentives than hospitals in a National Health Service (NHS). In order to add to the literature, this study aims to understand what happens in a NHS. Results reveal a statistically significant correlation between volume of procedures and better outcomes for the following medical procedures: cerebral infarction, respiratory infections, circulatory disorders with AMI, bowel procedures, cirrhosis, and hip and femur procedures. The effect is explained with the practice-makes-perfect hypothesis through static effects of scale with little evidence of learning-by-doing. The centralization of those medical procedures is recommended given that this policy would save a considerable number of lives (reduction of 12% in deaths for cerebral infarction).

Implementação da Equipa de Emergência Médica Intra-hospitalar nos hospitais do Serviço Nacional de Saúde : análise de custo-efetividade perante a incidência da paragem cárdio-respiratória intra-hospitalar

RESUMO - Introdução: No âmbito das emergências intra-hospitalares investigou-se a hipótese da presença da Equipa Emergência Médica Intra-hospitalar (EEMI) (DGS, 2010) num Centro Hospitalar (CH), contribuir para a redução do número de mortos por Paragem Cárdiorespiratória (PCR) intra-hospitalar, quando comparado com outro CH dotado de uma equipa tradicional de resposta à PCR. Metodologia: Tratou-se de um estudo observacional, retrospetivo (2010 a 2014), com base nos dados do Grupo de Diagnóstico Homogéneo (GDH), analisado numa perspetiva de custo-efetividade no impacto sobre incidência de PCR e taxa de mortalidade. Resultados: Observou-se que o CH com EEMI apresentou uma Redução Risco Absoluto (RRA) de 9,01% de morte por PCR. A taxa de mortalidade calculada foi de 2,82 casos por 1000 episódios de internamento em que a incidência de PCR foi de 28,24 casos por cada 10 000 habitantes, duas vezes menor que CH em comparação. Quando introduzidas manobras de Ressuscitação Cárdiopulmonar (RCP), o mesmo CH teve um maior número de PCR revertidas, com uma taxa de mortalidade 2 vezes menor que o CH sem EEMI. Conclusão: Resultados demonstraram que os dois CH apresentaram riscos diferentes, em que a probabilidade do doente hospitalizado de morrer após ocorrência de PCR foi menor no grupo exposto à EEMI, com OR = 0,496 [IC 95% (0,372 a 0,662)] para dados populacionais (p = 0,0013), e OR = 0,618 [IC 95% (0,298 a 1,281)] para dados individuais, (p = 0,194). Face a melhores resultados em Saúde, considerou-se a implementação da EEMI, uma medida custo-efetiva, uma vez que o principal requisito traduz-se por reorganização das equipas tradicionais para uma vertente de prevenção da PCR.

Low blood glucose levels and other complications during growth hormone supplementation in sepsis

Blood glucose levels in the high normal range or even moderate hyperglycemia is the expected profile in septic postoperative patients receiving high-calorie enteral alimentation. The addition of growth hormone as an anabolic agent should additionally reinforce this tendency. In a cancer patient undergoing partial gastrectomy with lymphadenectomy and suffering from postoperative subphrenic abscess and prolonged sepsis, tube feeding (38.3 kcal/kg/day) and growth hormone (0.17 IU/kg/day) were simultaneously administered for 25 days. Blood glucose levels were in the lower limits of the normal range before growth hormone introduction, and continued with a similar tendency during most of the therapeutic period. Two additional complications, namely heart arrest and peripheral edema, were documented during the same period. It is concluded that sepsis was the most likely mechanism for low glucose values, and that high-calorie enteral diet and growth hormone supplementation did not prevent that result. It is uncertain whether heart arrest was due to the drug, but its association with peripheral edema is well documented in clinical series.