Induced Labor– Is There an Increased Risk of Perinatal Infection?

Objectives: To assess induced labor-associated perinatal infection risk at Hospital D.Estefânia from January to June of 2010 at Hospital de D. Estefânia’s delivery rooms, reviewing the indications for inducing labor as well as the techniques used. Material and Methods: Performing an historical prospective study searching the clinical processes as well as the mother and newborn’s computer database from January to June of 2010. An exposed and an unexposed group were created; the first group comprises pregnant women and their newborns whose labor was induced. The unexposed group is constituted by newborns and pregnant women whose labor was spontaneous. Labor induction was performed using intra-vaginal prostaglandins in women who didn’t start it spontaneously; perinatal infection was defined either clinically or using blood tests. The gestational age was ≥ 37 weeks for both groups. 19 variables were studied for both groups. Results: A total of 190 mother-newborn pairs were included: 55 in the exposed group and 135 in the unexposed group. 3 cases of perinatal infection were reported, two in the exposed group and one in the unexposed group. Preliminary data resulted in a perinatal infection rate of 3.6% in the exposed group and 0.7% in the unexposed group; preliminary data suggest that the risk of perinatal infection may be increased in up to 5-fold when labor is inducted. Conclusions: A larger series of patients and a multivariable analysis using logistic regression are both necessary in order to perform a more thorough assessment of labor induction’s role in perinatal infection risk. One must also try to distinguish labor inducing- and clinical practicesrelated factors.

Laparoscopic Assisted Vaginal Hysterectomy Versus Vaginal Hysterectomy

Introduction: Hysterectomy is the commonest gynecologic operation, performed for malignant and benign conditions. There are many approaches to hysterectomy for benign disease. Studies comparing the techniques have showed that vaginal hysterectomy has benefits in terms of reduced hospital stay, faster recovery and less operating time. Objective: The purpose of this study is to compare the surgical and immediate postoperative outcomes of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) with those of Vaginal Hysterectomy (VH). Methods: Retrospective descriptive study, comparing two groups of women who underwent LAVH or VH in our department during a 24 months period, from January 2009 to December 2010. The two groups were compared regarding age, vaginal deliveries, previous abdominal surgery, uterine and adnexal pathology, intra-operative and post-operative complications, uterus weight, blood loss and number of days until discharge. Results: In our study 42 LAVH and 99 VH were included, with a patient mean age of 47 and 59, respectively. The most frequent indication for hysterectomy was fibroids (80%) for LAVH and POP(58.6%) for HV. In LAVH group 47.6% of patients had previous abdominal surgery, vs 28.2% in VH group. The medium operative time was 167 minutes for LAVH vs 99 minutes for HV. The intra-operative complications were one case (2%) of accidental incision of rectum in LAVH, and one bladder incision in the VH (1%). There were 3 conversions to laparotomy for difficult technique (7%) in LAVH group. There were no significant post-operative complications for LAVH. In VH group there were 2 cases of haemoperitoneum (2%) and 1 case requiring blood transfusion (1%). The mean time for discharge was 4.23 days for LAVH and 4.46 days for VH. Conclusions: In our study, the main advantage for VH was the reduced operative time. In terms of time to discharge there was no difference between the 2 groups. The main intra-operative complication of LAVH was the risk of conversion to laparotomy, but post-operatively this procedure had fewer complications than VH. In conclusion, LAVH is a safe option for women requiring hysterectomy in cases where VH is anticipated to be technically difficult.

Ocular Toxoplasmosis Reactivation During Pregnancy – A Case Report

Introduction: Toxoplasmosis is caused by Toxoplasma gondii and may be acquired from food or water contaminated with cat feces or by vertical transmission. Severe fetal complications can overcome during pregnancy. There are also rare case-reports of congenital toxoplasmosis from previously immunized pregnant women; usually these women being had prior retinal toxoplasmic lesions. Immunosuppresion is one of the risk factors which accounts for some of these cases. Case report: 30 year-old pregnant woman, OI 2002, brazilian, previously healthy, admitted in Ophtalmology Department because of sudden left eye amaurosis in June, 2010. The fundoscopy revealed retinal scars suggesting previous infections; she was treated with corticoids and spiramycin for ocular toxoplasmosis reactivation. Previous serum analysis (2008) showed immunity to T. Gondii, but in July the IgM was negative and high levels of specific IgG were found (1227UI/mL). The serologic findings were later confirmed by a more accurate laboratory technique which found the IgM to be also positive. An amniocentesis was performed and it was negative for fetal transmission. Clinical and ultrasound follow-up throughout the rest of the gestational period was normal; daily spiramycin intake was maintained. An uneventful term delivery was performed. Neither the newborn’s serum analysis nor the histopathological study of the placenta were positive for congenital infection. Conclusion: Toxoplasmosis reactivation in pregnant women without immunosuppression is rare but is more likely to occur if previous post-infectious retinal scars are present. T. gondii infection is endemic in Brazil, so the geographical origin is important. If risk factors are present, fundoscopy should be performed every three months during pregnancy and one should always be aware of any visual symptoms. If you suspect reactivation, start medical prophylaxis for fetal transmission, perform amniocentesis and regular ultrasound follow-up.

Ruptura Uterina - A Propósito de 2 Casos Clínicos

Introdução: A ruptura uterina leva a consequências graves materno-fetais. A maioria dos casos ocorre em grávidas com cesarianas anteriores ou incisões uterinas prévias como miomectomia, raramente ocorrendo em úteros sem cicatrizes. Um dos principais factores correlacionado com o risco de ruptura é o tipo de incisão da histerotomia prévia: clássica (4-9%), em T (4-9%), vertical (1-7%); transversa (0,2-1,5%). Outros factores de risco são: ausência de parto vaginal anterior, indução do trabalho de parto, gravidez de termo, macrossomia fetal, multiparidade, sutura simples vs.dupla na histerorrafia prévia e intervalo curto entre gestações. 1-Caso clínico: Grávida, 28 anos, IO 2002 (cesariana em 2002 por apresentação pélvica; PTE em 2009), enviada ao nosso hospital para esclarecimento de anemia às 21 semanas. A gravidez decorreu normalmente; entrando espontaneamente em trabalho de parto em Agosto/2010. No período expulsivo a grávida referiu dor pélvica súbita com irradiação lombar. Teve um parto eutócico com distócia de ombros leve. Duas horas após, a puérpera apresentava-se inquieta, pálida e hipotensa comHb de 7,3g/dl. Decidiu-se laparotomia, constatando-se ruptura uterina no segmento inferior com prolongamento para a parede posterior, realizando-se histerorrafia.Pós-operatório sem intercorrências. 2-Caso clínico: Grávida, 41 anos, IO 0000, antecedentes pessoais de miomectomia por laparoscopia sem entrada na cavidade em 2008 e 2009, enviada ao nosso hospital para Consulta de DPN. Foi internada às 17+3 semanas para IMG por alteração do cariótipo fetal (Trissomia 21). Iniciou-se o protocolo para IMG aplicando-se unicamente 100 microg de misoprostol;24 horas após, a doente encontrava-se agitada e hipotensa, com episódio de lipotímia. Realizou-se laparotomia com visualização de ruptura uterina fúndica, corrigida com histerorrafia sem intercorrências Conclusão: Dada amorbi/mortalidade materno-fetal associada à ruptura uterina é fundamental reconhecer os factores de risco e os sintomas associados a esta, tal como o seu diagnóstico atempado e resolução imediata, minimizando os riscos materno-fetais.

Two Gestational Sacs, Two Locations - Heterotopic Pregnancy - Case Report

Introduction: Heterotopic pregnancy (HP) is defined as two gestational sacs simultaneously present in two different locations, being the uterus and the fallopian tubes the more common. Sporadic HP is a very rare condition (1:30,000 pregnancies). With the use of medically assisted reproduction the prevalence is significantly higher(1:7,000). Considering spontaneous pregnancy, HP is associated with risk factors, being prior inflammatory pelvic disease the most common. The clinical presentation is similar to that of ectopic pregnancy or spontaneous miscarriage although it is usually a more late diagnosis. Case report: 25 year-old pregnant woman, OI 0000, previously healthy; admitted at the Emergency Department (ED) with acute pelvic pain mainly at the right iliac fossa and moderate vaginal bleeding confirmed by speculum examination. She was hemodynamically stable and the bimanual palpation was painful; no prior medically assisted reproduction technique had been performed. The haemoglobin value was within normal range and the serum β-hCG was 2,763mUI/mL. The ultrasonography at the ED showed an in uterus gestational sac and another one inside the right fallopian tube; in both gestational sacs cardiac activity was absent. HP diagnosis was then established and the patient was admitted at the Obstetrics Ward for surveillance and ultrasonographic/laboratorial reassessment; complete miscarriage of the uterine pregnancy occurred but methotrexate was necessary for the treatment of persistent tubarian pregnancy. Conclusion: When evaluating a pregnant woman with pelvic pain and vaginal bleeding one should always be aware of several differential diagnosis amongst which HP should be considered. If the patient has in uterus viable pregnancy the treatment of the ectopic concomitant gestational sac should be as conservative as possible; methotrexate should not be used in that situation as it leads to uterine pregnancy miscarriage in about one third of the patients.

Confined Placental Mosaicism in Chorionic Vilus Sampling - Case Report

Objectives: Chorionic Vilus Sampling (CVS) has several advantages over amniocentesis: it may be performed at an earlier gestational age, the results are quicker to obtain and there’s a lower miscarriage risk – 1%. However, the higher prevalence of discrepant fetal and vilus sampling material’s karyotype findings is a disadvantage of this technique – 0.5%. This is caused, amongst other causes, by placental mosaicism which consists of two genetically different cell lines. There are three types of placental mosaicism according to the abnormal cell line location: Type I – in the cytotrophoblast; Type II – in the vilus’ stroma; Type III – in both the above locations. Material and Methods: We present a case report about a 36-year-old pregnant woman going through our Department’s 1st trimester combined screening program; a CVS was performed, which showed Confined Placental Mosaicism (CPM). Results and Conclusion: Although the pregnant woman was in the low-risk group for aneuploidy, the patient wanted the cytogenetic study to be performed in order to reduce maternal anxiety. CVS was performed at the gestational age of 12 weeks + 5 days and the karyotype was 47XY+2/46XY. For the correct interpretation of this data an amniocentesis was performed at the gestational age of 15 weeks + 6 days, which showed a 46XY karyotype. We therefore conclude that the cytogenetic analysis of the CVS was the result of a CPM. A careful follow-up including fetal echocardiogram and seriated ultrasonographic monitoring was used to safely exclude malformations and fetal growth restriction. We verified no occurences throughout pregnancy, delivery and perinatal period. CVS practice was recently implemented in our country and has many advantages over amniocentesis. Besides the fact that an earlier gestational age usually means less affective bonding to the fetus and therefore makes medical termination of pregnancy somewhat less difficult, one should consider specific situations like the one reported in which CPM may be diagnosed. This condition is associated with increased risk of fetal growth restriction, so the clinician should be aware of the need for a more careful follow-up, since perinatal complications, which should be anticipated and treated, can be expected in 16-21% of these cases.

Produção de biohidrogénio a partir de diferentes fontes de carbono, por fermentação anaeróbia

Dissertação para a obtenção do Grau de Mestre em Energia e Bioenergia

Um estudo sobre geometria no 1.º ciclo: simetria em figuras planas

Este estudo insere-se no âmbito da Geometria e pretende compreender a influência dos recursos didáticos utilizados no reconhecimento de propriedades e relações geométricas em figuras planas. De acordo com o objetivo do estudo formulamos duas questões orientadoras que se articulam entre si. - Que fragilidades apresentam os alunos, no reconhecimento de propriedades geométricas em figuras planas? - Que contributos resultam da utilização de materiais manipuláveis, na visualização espacial e investigação de propriedades geométricas? Com este estudo pretendemos reunir informação que contribua para aprofundar o conhecimento sobre o raciocínio geométrico dos alunos. Em termos metodológicos segue um método de investigação misto, com recolha de informação qualitativa de natureza interpretativa e quantitativa, na modalidade de estudo de caso. A recolha de dados foi realizada numa turma de 4.º ano do ensino básico onde foi desenvolvida a experiência didática. A informação recolhida resultou da observação direta e as fontes dos dados foram as produções dos alunos, as notas de campo, registos fotográficos, vídeo e áudio. A docente assumiu o papel de investigadora e orientadora das tarefas propostas aos alunos tendo estes desempenhado um papel ativo na construção do seu próprio conhecimento. Os resultados obtidos permitem evidenciar as fragilidades dos alunos no reconhecimento de propriedades geométricas de figuras planas em diferentes posições. Destacam ainda os contributos da utilização da Mira e do Tangram, no estudo da simetria e no desenvolvimento da visualização espacial para a concretização de aprendizagens concretas, motivadoras e significativas.

Das sombras de Platão ao realismo de Iracema: a representação do real no cinema

Dissertação apresentada para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Ciências da Comunicação, vertente Cinema e Televisão,

Melhoria da comunicação entre EE e professores numa escola do 1º ciclo - estudo de caso

O presente trabalho propõe-se compreender de que forma ocorre a comunicação entre encarregados de educação e professores, numa escola básica do primeiro ciclo, enquadrado numa abordagem comunicacional das relações nas organizações escolares. A comunicação é, sem dúvida, um processo que é utilizado como ferramenta pelos gestores e pelos diferentes atores educacionais. Assim, os processos de comunicação assumem um papel fulcral na solidificação das relações internas e externas de qualquer organização. Este trabalho visa, assim, contribuir para o desenvolvimento de estratégias que potenciem a melhoria e o conhecimento da importância da comunicação como um processo influente na estruturação da relação encarregados de educação e escola. Através das representações que os difentes atores envolvidos neste estudo detêm da comunicação (encarregados de educação e professores), identifiquei alguns problemas comunicacionais que terão eventualmente influência na das relações entre os professores e os encarregados de educação, bem como propus no plano de ação estratégias para os resolver.

Caraterização dos Maus Utilizadores de Cheques: Uma Exploração do Caso Português

Dissertação apresentada como requisito parcial para obtenção do grau de Mestre em Estatística e Gestão de Informação.

Aplicação do controlo estatístico do processo numa indústria panificadora

Dissertação para obtenção do Grau de Mestre em Engenharia e Gestão Industrial

Contributos para a avaliação do potencial de produção de energia em contexto urbano – Caso de Beja, Portugal

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

Office Hysteroscopy After Ultrasonographic Diagnosis of Thickened Endometrium in Postmenopausal Patients

The aim of our study was to access office hysteroscopy results in postmenopausal patients with thickened endometrium. A retrospective descriptive study was carried out on 245 postmenopausal patients submitted to office hysteroscopy after sonographic diagnosis of thickened endometriumin 20 consecutive months.Women were evaluated for age, hormonal therapy, hysteroscopic findings, procedure duration, complications and associated pain, and histological diagnosis. Patients with and without uterine bleeding were considered separately. Symptomatic patients were older and had longer procedure duration. The most frequent hysteroscopic finding was endometrial polyp in both groups. Pain was subjectively assessed in a numeric scale from 0 to 10 and median value was 4. There were no complications reported. Global neoplasia rate was 2.9% for asymptomatic patients and 16.4% for symptomatic ones (p<0.05). Thickened endometrium with postmenopausal metrorrhagia gave patients a significantly higher risk for neoplasia and hyperplasia.

SEROLOGICAL DETECTION OF HEPATITIS A VIRUS IN FREE-RANGING NEOTROPICAL PRIMATES (Sapajus spp., Alouatta caraya) FROM THE PARANÁ RIVER BASIN, BRAZIL

Nonhuman primates are considered as the natural hosts of Hepatitis A virus (HAV), as well as other pathogens, and can serve as natural sentinels to investigate epizootics and endemic diseases that are of public health importance. During this study, blood samples were collected from 112 Neotropical primates (NTPs) (Sapajus nigritus and S. cay, n = 75; Alouatta caraya, n = 37) trap-captured at the Paraná River basin, Brazil, located between the States of Paraná and Mato Grosso do Sul. Anti-HAV IgG antibodies were detected in 4.5% (5/112) of NTPs, specifically in 6.7% (5/75) of Sapajus spp. and 0% (0/37) of A. caraya. In addition, all samples were negative for the presence of IgM anti-HAV antibodies. These results suggest that free-ranging NTPs were exposed to HAV within the geographical regions evaluated.