Taquicardia ventricular idiopática : estudo de correlação do ECG com o local de origem

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Avaliação nutricional e antropométrica de praticantes de exercício físico em ginásio

A preocupação acrescida com a condição e aparência física, refletem-se em cuidados com o estado de saúde e bem-estar e são, nos últimos anos, responsáveis pela expansão dos ginásios e health clubs.Mas, atividade física e a alimentação estão intimamente ligadas, tanto no que respeita à estética como também, com maiores preocupações, no que respeita à saúde. Daí que as duas vertentes estejam ligadas à imagem de pessoas saudáveis e vigorosas. Na verdade, a capacidade de rendimento do organismo melhora com a nutrição adequada. A avaliação da composição corporal é um importante aspeto na determinação da condição física e permite-nos observar as alterações fisiológicas produzidas pelos programas de atividade física e/ou alimentares, oferecendo informações quanto a sua eficiência ou possíveis correções a serem efetuadas. Pretendeu-se com o presente estudo caracterizar os hábitos alimentares e a composição corporal dos indivíduos praticantes de exercício físico num ginásio do Concelho de Coimbra. A amostra foi constituída por 50 indivíduos, 22 do sexo masculino e 28 do sexo feminino, com idades compreendidas entre os 18 e os 57 anos. Estes indivíduos têm em comum o facto de praticarem exercício físico num mesmo ginásio, de uma forma sistemática há pelo menos 6 meses. Para a caracterização dos hábitos de AF dos participantes no estudo foi utilizada a versão curta do International Physical Activity Questionnaire (IPAQ). Para avaliação nutricional recorreu-se ao Questionário Semiquantitativo de Frequência Alimentar (QSFA), elaborado pelo Serviço de Higiene e Epidemiologia da Faculdade de Medicina da Universidade do Porto. A conversão dos alimentos em nutrientes foi realizada recorrendo ao programa informático Food Processor Plus ® versão 7.0. Foram ainda avaliados os seguintes parâmetros antropométricos: peso, altura, perímetro abdominal, IMC, massa gorda e massa magra. As análises estatísticas foram efetuadas com recurso ao Programa Estatístico SPSS (Statistical Package for the Sciences) para o Windows, versão 20.0. O nível de significância estatística foi mantida em 5% (p<0,05). A análise dos dados permitiu retirar as seguintes conclusões: Os frequentadores de ginásio são na sua maioria indivíduos do sexo feminino (56%), jovens com uma idade média de 27±7 anos. A maioria dos participantes do estudo praticava EF (exercício físico) há 39 meses, no entanto no grupo existe uma grande variabilidade, existindo indivíduos que praticam EF há 6 meses, e outros que o fazem há 180 meses. Praticam EF com uma frequência média de 3,5±1,3 sessões/semana a que corresponde uma prática de EF 6,40±3,2 h/semana. A maioria apresentava um Perímetro Abdominal (PA) de 85,2±6,3 cm, Índice de Massa Corporal (IMC) normal (23,1± 2,6 kg/m2), valores de Massa Gorda (MG) (23,9%) e de Massa Muscular (MM) de 34,6±7,9%. Observou-se uma diminuição da MG com o tempo de prática de exercício de 25,3% (praticantes entre 6-12 meses) vs 20,9% (praticantes> 48 meses). Esta influência temporal, embora sem significado estatístico, verifica-se também relativamente ao perímetro abdominal e IMC, embora neste último numa razão inversa, caracterizada pelo seu aumento. O tipo de exercício praticado influencia a composição corporal: praticantes de exercício aeróbio apresentam um perímetro abdominal inferior (82,3±6,0 cm) aos praticantes de outro tipo de exercícios porém acompanhado de uma percentagem de massa gorda superior (29,4±6,0%).Os praticantes de exercício de resistência apresentam valores de MG de 16,0±7,4%. No estudo por nós realizado, constatou-se inadequação na quantidade energética consumida, face às necessidades efetivas da amostra. Embora a ingestão de hidratos de carbono, de fibra e de lípidos se apresente dentro dos limites recomendados a ingestão de proteína ultrapassa os valores recomendados.Os resultados obtidos mostram que o tipo de exercício bem como o tempo de prática de exercício influenciam a composição corporal. Verificou-se ainda que a alimentação dos participantes no estudo não é adequada do ponto de vista nutricional e para além disso os hábitos nutricionais não parecem influir na composição corporal da amostra. Mais estudos serão necessários para que os hábitos alimentares dos praticantes de exercício em ginásios e health clubs sejam bem conhecidos e os profissionais da área tenham mais informações e possam orientar melhor os praticantes de exercício físico regular em ginásios e health clubs de modo a otimizar os resultados pretendidos através de um aconselhamento nutricional individualizado.

Notificação de incidentes e segurança do doente : perceção dos enfermeiros

Enquadramento: A segurança do doente é um problema internacional e uma prioridade das políticas de saúde de múltiplos organismos/instituições nacionais de saúde. Neste âmbito, surgem os sistemas de notificação de incidentes. Objetivo: Conhecer a perceção dos enfermeiros sobre a notificação de incidentes e sobre a segurança do doente. Métodos: Recorremos a uma triangulação metodológica constituída por um estudo quantitativo (estudo A) e outro qualitativo (estudo B). O estudo A é analítico, transversal, realizado com 182 enfermeiros. Os dados foram recolhidos por questionário, constituído por variáveis sociodemográficas e profissionais e escalas para avaliar doze dimensões da notificação e segurança do doente. O estudo B é exploratório, realizado com 18 enfermeiros, através de entrevista semiestruturada. Resultados: Para os enfermeiros todos os incidentes devem ser notificados, mas a frequência de notificação é baixa e diminui com a gravidade do dano, 65,0% não registou qualquer ocorrência no último ano e 82,3% desconhece o sistema de notificação. Os principais obstáculos à notificação são o receio de punição e os principais fatores facilitadores são os benefícios que advêm da notificação para o doente, a ausência de retaliações no trabalho, uma relação positiva com os superiores hierárquicos, o anonimato e a perceção de resultados da notificação. Aproximadamente 60,0% dos enfermeiros tem uma perceção geral da segurança do doente positiva. Conclusão: A perceção dos enfermeiros sobre a notificação de incidentes reflete desconhecimento da temática, elevado receio de punição, originando baixa frequência de notificação. A perceção sobre a segurança do doente é positiva. É necessário melhorar a cultura de segurança da organização e o conhecimento dos enfermeiros sobre o papel da notificação. Palavras-Chave: segurança do doente, notificação de incidentes, enfermeiros.

Recommendations for Genetic Testing to Reduce the Incidence of Anthracycline-induced Cardiotoxicity

AIM Anthracycline-induced cardiotoxicity (ACT) occurs in 57% of treated patients and remains an important limitation of anthracycline-based chemotherapy. In various genetic association studies, potential genetic risk markers for ACT have been identified. Therefore, we developed evidence-based clinical practice recommendations for pharmacogenomic testing to further individualize therapy based on ACT risk. METHODS We followed a standard guideline development process; including a systematic literature search, evidence synthesis and critical appraisal, and the development of clinical practice recommendations with an international expert group. RESULTS RARG rs2229774, SLC28A3 rs7853758 and UGT1A6 rs17863783 variants currently have the strongest and the most consistent evidence for association with ACT. Genetic variants in ABCC1, ABCC2, ABCC5, ABCB1, ABCB4, CBR3, RAC2, NCF4, CYBA, GSTP1, CAT, SULT2B1, POR, HAS3, SLC22A7, SCL22A17, HFE and NOS3 have also been associated with ACT, but require additional validation. We recommend pharmacogenomic testing for the RARG rs2229774 (S427L), SLC28A3 rs7853758 (L461L) and UGT1A6*4 rs17863783 (V209V) variants in childhood cancer patients with an indication for doxorubicin or daunorubicin therapy (Level B - moderate). Based on an overall risk stratification, taking into account genetic and clinical risk factors, we recommend a number of management options including increased frequency of echocardiogram monitoring, follow-up, as well as therapeutic options within the current standard of clinical practice. CONCLUSIONS Existing evidence demonstrates that genetic factors have the potential to improve the discrimination between individuals at higher and lower risk of ACT. Genetic testing may therefore support both patient care decisions and evidence development for an improved prevention of ACT.

Nitrogen isotope ratios of Cretaceous Atlantic sedimentary sequences

At two locations in the Atlantic Ocean (DSDP Sites 367 and 530) early to middle Cretaceous organic-carbon-rich beds (black shales) were found to have significantly lower delta15N values (lower 15N/14N ratios) than adjacent organic-carbon-poor beds (white limestones or green claystones). While these lithologies are of marine origin, the black strata in particular have delta15N values that are significantly lower than those previously found in the marine sediment record and most contemporary marine nitrogen pools. In contrast, black, organic-carbon-rich beds at a third site (DSDP Site 603) contain predominantly terrestrial organic matter and have C- and N-isotopic compositions similar to organic matter of modern terrestrial origin. The recurring 15N depletion in the marine-derived Cretaceous sequences prove that the nitrogen they contain is the end result of an episodic and atypical biogeochemistry. Existing isotopic and other data indicate that the low 15N relative abundance is the consequence of pelagic rather than post-depositional processes. Reduced ocean circulation, increased denitrification, and, hence, reduced euphoric zone nitrate availability may have led to Cretaceous phytoplankton assemblages that were periodically dominated by N2-fixing blue-green algae, a possible source of this sediment 15N-depletion. Lack of parallel isotopic shifts in Cretaceous terrestrially-derived nitrogen (Site 603) argues that the above change in nitrogen cycling during this period did not extend beyond the marine environment.

Regulation of cancer-causing food additives, time for a change? : report to the Congress /

"B-20531."--Prelim. p.

Public papers of the Presidents of the United States.

"Containing the public messages, speeches, and statements of the President", <1956-1992>.

Lake Front Highway (F.A.P. 437) from Illinois Tri-State Tollway (I-94) to Grand Avenue (Illinois 132) in Lake County, Illinois : draft environmental impact statement.

Includes index.

Nonbreeding Eastern Curlews Numenius madagascariensis Do Not Increase the Rate of Intake or Digestive Efficiency before Long-Distance Migration because of an Apparent Digestive Constraint

The possibility of premigratory modulation in gastric digestive performance was investigated in a long-distance migrant, the eastern curlew (Numenius madagascariensis), in eastern Australia. The rate of intake in the curlews was limited by the rate of digestion but not by food availability. It was hypothesized that before migration, eastern curlews would meet the increased energy demand by increasing energy consumption. It was predicted that (1) an increase in the rate of intake and the corresponding rate of gastric throughput would occur or (2) the gastric digestive efficiency would increase between the mid-nonbreeding and premigratory periods. Neither crude intake rate (the rate of intake calculated including inactive pauses; 0.22 g DM [grams dry mass] or 3.09 kJ min(-1)) nor the rate of gastric throughput (0.15 g DM or 2.85 kJ min(-1)) changed over time. Gastric digestive efficiency did not improve between the periods (91%) nor did the estimated overall energy assimilation efficiency (63% and 58%, respectively). It was concluded that the crustacean-dominated diet of the birds is processed at its highest rate and efficiency throughout a season. It appears that without a qualitative shift in diet, no increase in intake rate is possible. Accepting these findings at their face value poses the question of how and over what time period the eastern curlews store the nutrients necessary for the ensuing long, northward nonstop flight.

Inheritance of early Archaean Pb-isotope variability from long-lived Hadean protocrust

Comparison of initial Pb-isotope signatures of several early Archaean (3.65-3.82 Ga) lithologies (orthogneisses and metasediments) and minerals (feldspar and galena) documents the existence of substantial isotopic heterogeneity in the early Archaean, particularly in the Pb-207/Pb-204 ratio. The magnitude of isotopic variability at 3.82-3.65 Ga requires source separation between 4.3 and 4.1 Ga, depending on the extent of U/Pb fractionation possible in the early Earth. The isotopic heterogeneity could reflect the coexistence of enriched and depleted mantle domains or the separation of a terrestrial protocrust with a U-238/Pb-204 (mu) that was ca. 20-30% higher than coeval mantle. We prefer this latter explanation because the high-p signature is most evident in metasediments (that formed at the Earth's surface). This interpretation is strengthened by the fact that no straightforward mantle model can be constructed for these high-mu lithologies without violating bulk silicate Earth constraints. The Pb-isotope evidence for a long-lived protocrust complements similar Hf-isotope data from the Earth's oldest zircons, which also require an origin from an enriched (low Lu/Hf) environment. A model is developed in which greater than or equal to3.8-Ga tonalite and monzodiorite gneiss precursors (for one of which we provide zircon U-Pb data) are not mantle-derived but formed by remelting or differentiation of ancient (ca. 4.3 Ga) basaltic crust which had evolved with a higher U/Pb ratio than coeval mantle in the absence of the subduction process. With the initiation of terrestrial subduction at, we propose, ca. 3.75 Ga, most of the greater than or equal to3.8-Ga basaltic shell (and its differentiation products) was recycled into the mantle, because of the lack of a stabilising mantle lithosphere. We argue that the key event for preservation of all greater than or equal to3.8-Ga terrestrial crust was the intrusion of voluminous granitoids immediately after establishment of global subduction because of complementary creation of a lithospheric keel. Furthermore, we argue that preservation of !3.8-Ga material (in situ rocks and zircons) globally is restricted to cratons with a high U/Pb source character (North Atlantic, Slave, Zimbabwe, Yilgarn, and Wyoming), and that the Pb-isotope systematics of these provinces are ultimately explained by reworking of material that was derived from ca. 4.3 Ga (i.e. Hadean) basaltic crust.

Violence against young Australian women and association with reproductive events: a cross-sectional analysis of a national population sample

Objective: This study aimed to investigate associations between violence and younger women's reproductive events using Survey 1 (1996) data of the Younger cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Methods: Multinomial regression, using composite variables for both violence and reproductive events, adjusting for socioeconomic variables and weighted for rural and remote areas. Results: 23.8% of 14,784 women aged 18 to 23 years reported violence; 12.6% reported non-partner violence in the previous year; and 11.2% reported ever having had a violent relationship with a partner. Of the latter group, 43% (4.8% overall) also reported violence in the past year. Compared with women reporting no violence, women reporting partner but not recent violence (OR 2.55, 95% Cl 2.10-3.09) or partner and recent violence (OR 3.96, 95% Cl 3.18-4.93) were significantly more likely to have had one or more pregnancies. Conversely, having had a pregnancy (2,561) was associated with an 80% increase in prevalence of any violence and a 230% increase in partner violence. Among women who had a pregnancy, having had a miscarriage or termination was associated with violence. Partner and recent violence is strongly associated with having had a miscarriage, whether alone (OR = 2.85, 95% Cl 1.74-4.66), with a termination (OR = 4.60, 2.26-9.35), or with birth, miscarriage and a termination (OR 4.12, 1.89-9.00). Conclusions and implications: Violence among young women of childbearing age is a factor for which doctors should be vigilant, well-trained and supported to identify and manage effectively.

Genomewide linkage study in 1,176 affected sister pair families identifies a significant susceptibility locus for endometriosis on chromosome 10q26

Endometriosis is a common gynecological disease that affects up to 10% of women in their reproductive years. It causes pelvic pain, severe dysmenorrhea, and subfertility. The disease is defined as the presence of tissue resembling endometrium in sites outside the uterus. Its cause remains uncertain despite 150 years of hypothesis-driven research, and thus the therapeutic options are limited. Disease predisposition is inherited as a complex genetic trait, which provides an alternative route to understanding the disease. We seek to identify susceptibility loci, using a positional-cloning approach that starts with linkage analysis to identify genomic regions likely to harbor these genes. We conducted a linkage study of 1,176 families ( 931 from an Australian group and 245 from a U. K. group), each with at least two members-mainly affected sister pairs-with surgically diagnosed disease. We have identified a region of significant linkage on chromosome 10q26 ( maximum LOD score [MLS] of 3.09; genomewide P = .047) and another region of suggestive linkage on chromosome 20p13 MLS p 2.09). Minor peaks with MLS > 1.0) were found on chromosomes 2, 6, 7, 8, 12, 14, 15, and 17. This is the first report of linkage to a major locus for endometriosis. The findings will facilitate discovery of novel positional genetic variants that influence the risk of developing this debilitating disease. Greater understanding of the aberrant cellular and molecular mechanisms involved in the etiology and pathophysiology of endometriosis should lead to better diagnostic methods and targeted treatments.