Suspecting Renal Artery Thrombosis

Renal artery thrombosis is a threatening clinical diagnosis, in which renal infarction may occur. Often misdiagnosed, for mimicking other common diseases, it should be considered in persistent flank pain to improve care and reduce morbidity. We review a case of a healthy, 57 year-old woman with renal artery thrombosis mimicking pyelonephritis and renal calculus obstruction, highlighting features of this clinical condition. An accurate diagnosis is essential for optimal management and prompts treatment, which still remains to be defined.

Hematoma sublingual espontáneo secundario a terapia anticoagulante con warfarina

Abstract Hemorrhagic complications in oral anticoagulant therapy are frequent. Spontaneous sublingual hematomas secondary to anticoagulants are an extremely unusual complication that is potentially lethal. The study reports a case of a patient on anticoagulation therapy with warfarine who develops a massive, spontaneous sublingual hematoma with obstruction of the high airway and cardiac arrest, where emergency transtracheal catheter ventilation was used.

A Rare Manifestation of Crohn's Disease: Sinonasal Granulomatosis. Report of a Case and Review of Literature

Crohn’s disease is a granulomatous inflammatory bowel disease. Its pathologic findings include non-contiguous chronic inflammation and non-caseating granulomas, sometimes with extra-intestinal localizations. Sinonasal manifestations of Crohn’s disease are quite rare and only a few cases have been reported up to date in the worldwide literature. They are characterized by chronic mucosal inflammation, obstruction, bleeding and occasionally septal perforation. We report a case of sinonasal granulomatosis revealing Crohn’s disease in a 22-year-old woman and go over the available literature on sinonasal involvement in Crohn’s disease.

Sensoriamento óptico quase-distribuído aplicado ao monitoramento de trocadores de calor de usinas hidrelétricas

This work aims to develop optical sensors for temperature monitoring in hydroelectric power plant heat exchangers. The proposed sensors are based on the Fiber Bragg Gratings technology. First of all, a prototype with three sensors inscribed in a same fiber was developed. This fiber was then fixed to a conventional Pt100 sensor rod and inserted in a thermowell. The ensemble was then calibrated in a workbench, presenting a maximum combined uncertainty of 2,06 °C. The sensor was installed in one of the heat exchangers of the Salto Osório’s hydroelectric power plant. This power plant is situated in the Iguaçu river, at the Paraná state. Despite the satisfactory results, the sensor was improved to a second version. In this, fifteen optical Bragg sensors were inscribed in a same fiber. The fixation with a conventional sensor was no longer necessary, because the first version results comproved the efficiency and response time in comparison to a conventional sensor. For this reason, it was decided to position the fiber inside a stainless steel rod, due to his low thermal expansion coefficient and high corrosion immunity. The utilization of fifteen fiber Bragg gratings aims to improve the sensor spatial resolution. Therefore, measurements every ten centimeters with respect to the heat exchanger’s height are possible. This provides the generation of a thermal map of the heat exchanger’s surface, which can be used for determination of possible points of obstruction in the hydraulic circuit of the heat exchanger. The heat exchanger’s obstruction in hydroelectric power plants usually occur by bio-fouling, and has direct influence in the generator’s cooling system efficiency. The obtained results have demonstrated the feasibility in application of the optical sensors technology in hydroelectric power plants.

Alternating surgeries

This thesis is concerned with the question of when the double branched cover of an alternating knot can arise by Dehn surgery on a knot in S^3. We approach this problem using a surgery obstruction, first developed by Greene, which combines Donaldson's Diagonalization Theorem with the $d$-invariants of Ozsvath and Szabo's Heegaard Floer homology. This obstruction shows that if the double branched cover of an alternating knot or link L arises by surgery on S^3, then for any alternating diagram the lattice associated to the Goeritz matrix takes the form of a changemaker lattice. By analyzing the structure of changemaker lattices, we show that the double branched cover of L arises by non-integer surgery on S^3 if and only if L has an alternating diagram which can be obtained by rational tangle replacement on an almost-alternating diagram of the unknot. When one considers half-integer surgery the resulting tangle replacement is simply a crossing change. This allows us to show that an alternating knot has unknotting number one if and only if it has an unknotting crossing in every alternating diagram. These techniques also produce several other interesting results: they have applications to characterizing slopes of torus knots; they produce a new proof for a theorem of Tsukamoto on the structure of almost-alternating diagrams of the unknot; and they provide several bounds on surgeries producing the double branched covers of alternating knots which are direct generalizations of results previously known for lens space surgeries. Here, a rational number p/q is said to be characterizing slope for K in S^3 if the oriented homeomorphism type of the manifold obtained by p/q-surgery on K determines K uniquely. The thesis begins with an exposition of the changemaker surgery obstruction, giving an amalgamation of results due to Gibbons, Greene and the author. It then gives background material on alternating knots and changemaker lattices. The latter part of the thesis is then taken up with the applications of this theory.

Aspiração de corpo estranho na criança: um perigo escondido

Introdução: A aspiração de corpo estranho (ACE) é uma emergência pediátrica e uma causa importante de morte acidental na criança. A maioria dos casos ocorre com objetos orgânicos e inorgânicos de pequenas dimensões, sobretudo em idade pré-escolar. A ACE cursa com amplo espectro de manifestações e o seu diagnóstico representa muitas vezes um desafio. Caso clínico: Descrevemos o caso clínico de uma criança de dois anos que recorreu ao Serviço de Urgência por tosse, disfonia e disfagia. Ao exame objetivo apresentava acessos de tosse estridulosa, tiragem supra-esternal ligeira e auscultação pulmonar com sibilos inspiratórios/expiratórios e roncos dispersos bilateralmente. A telerradiografia do tórax evidenciava um reforço hilar bilateral, mais notável à direita. A avaliação por Otorrinolaringologia, incluindo a nasolaringofibroscopia, não de- mostrou alterações. A broncoscopia revelou a presença de corpo estranho vegetal condicionando obstrução superior a 50% do lúmen do brônquio principal direito. Conclusão: Pretendemos com este caso salientar a necessidade de manter alto índice de suspeição perante a possibilidade de ACE, pois o atraso no seu reconhecimento condiciona o seu tratamento e o eventual aparecimento de sequelas irreversíveis.

Avaliação de parâmetros respiratórios por espirometria em trabalhadores da panificação da Cidade de Portimão

Desde os tempos da Roma Antiga que se associam problemas respiratórios a trabalhadores da panificação, em parte, provocados pela inalação de substâncias de alto peso molecular como farinhas. A espirometria é uma forma simples de estudar a ventilação pulmonar na qual se obtêm informações acerca de uma possível obstrução, restrição ou situação mista. Pretendeu-se avaliar a Capacidade Vital Forçada, o Volume Expiratório Máximo no Primeiro Segundo e a respectiva razão entre eles, recorrendo à espirometria em trabalhadores da panificação da cidade de Portimão, que aceitaram participar voluntariamente no estudo. A amostra final contemplou 48 trabalhadores. Através da análise dos resultados ficou patente que os trabalhadores com mais de 1O anos de serviço sofrem alterações na função respiratória estatisticamente significativa em relação aos valores de referência (p<0,05). Pode-se, por isso, afirmar que na cidade de Portimão, existe uma relação directa, numa perspectiva a longo prazo, entre a exposição à farinha e a obstrução respiratória. ABSTRACT; Since Rome Ancient times there has been an association between respiratory problems and bakery employees, in part because of the inhalation of substances of high molecular weight such as flours. Spirometry is a simple way to study pulmonary ventilation, through which one can obtain information about a possible obstruction, restriction or mixed situation. The aim of this study is to evaluate the Forced Vital Capacity, Forced Expiratory Volume in One Second and the ratio between them, using spirometry with volunteering bakery workers in the city of Portimão. The final sample compromised 48 workers. lt was evident that individuals working more than 1O years have statistically significant changes in respiratory function (p<0,05), when compared with reference values leading to the conclusion that in the city of Portimão, there is a direct relationship, in a long-term perspective, between exposure to flour and respiratory obstruction.

Flexible bronchoscopy contribution in the approach of diagnosis and treatment of children’s respiratory diseases: the experience of a unique pediatric unit in Tunisia.

Objective: Our study aimed at assessing the role of flexible bronchoscopy (FB) in improving diagnosis and management of children’s respiratory conditions in the pediatric unit of FB, newly created and unique in Tunisia. Methods: Retrospective study including all the FB achieved in our pediatric unit from 2009 to 2014. Results: We performed 365 FB in 333 patients aged 46 months on average (1 month - 15 years), often under conscious anesthesia (81.6%). FB was performed for diagnostic purposes in 341 cases and for therapeutic purposes in 24 cases. Eight anatomical abnormalities were revealed in 22 patients. An intraluminal bronchial obstruction was found in 71 FB, mainly due to a foreign body (n=36). A vascular anomaly was responsible for nine cases out of 17 extraluminal obstructions. Airways malacia was observed in 60 FB. Bronchoalveolar lavage was performed in 196 cases. It was determinant in 43.9% of the cases. FB was of great diagnostic value in 74.8% of the cases. It influenced the management of the patients in 58% of the cases. The FB for therapeutic purposes was beneficial in all cases. Few complications occurred (5.5%). Conclusion: FB is a safe tool providing precious diagnostic and/or therapeutic help for the clinician. Keywords:

Avaliação da conformidade de blocos cerâmicos para alvenaria de vedação produzidas na Região Integrada de Desenvolvimento da Grande Teresina

This research presents an outlook of the industries of red ceramic in the region next to the city of Teresina and an analysis of the ceramic products producted in this pole. The microregion investigated possesses 13 boroughs where were identified 32 ceramic in operation, being that 24 are located in Teresina, the ceramic region more important of Piauí, 1 is located in the city of Miguel Leão and 7 is located in Timon city that belongs to the state of Maranhão. The majority of ceramics are pulverized in these two cities, Teresina and Timon , responsible by a largely production independent of distance between fabric and consumer market. Furthermore, there is an artisanal production realized in other boroughs, mainly manual conformation bricks, where are producted diverse types of handicraft and ceramics utilitarian. The objective of this research is to evalue the conformity of ceramic blocks for brick of obstruction made by red ceramic industry of microregion at studying, verifying their pontentialities and adequacy in terms of production. In this research universe made a search of ceramic industries related to the Foundation CEPRO (Foundation Center of Research Social and Economic of Piauí). For the analysis of the ceramic products , were colected 60 crude bricks sample in three industries for their characterization, and 39 burned bricks sample for the Evaluation of Conformity. The results of the characterization made reached a accetptable standard in all formulations and temperature studied. The burned samples were applied to the geometric, physical and mechanical assays according to the ABNT standards (Brazilian Association of Technical Standards). The results of the physical assays showed that all the samples are at the same band recommended by standard. However, through the geometric assays just two industries did not present results according to the standard, due to lack of control in their process such as in their equipments. Taking into account the mechanical properties, only one industry investigated was not according to the standard

Interactions between drugs and drug-nutrient in enteral nutrition: a review based on evidences

Introduction: Enteral nutrition (EN) provides calories, macronutrients and micronutrients in adequate quantity and quality to meet the patient's needs. Some drugs when crushed and diluted may have their properties altered, including the reduction of bioavailability causing the reduction of the serum concentration of the drug; tube obstruction; drug-drug interaction or drug-nutrient interaction. Methods: The study was conducted through review of submitted articles in the databases of the Virtual Health Library (VHL): MEDLINE (National Library of Medicine, USA), Lilacs (Latin American and Caribbean Literature on Health Sciences) PUBMED - NCBI (National Center for Biotechnology Information) and COCHRANE. Results: For this survey, 42 articles were identified during database searching. After applying the inclusion and exclusion criteria, 08 articles were selected, obtained from the MEDLINE and Lilacs. Discussion: Some interactions were found such as the aluminium hydroxide and lactulose with the enteral nutrition, which may result in a precipitation and reduction of drug bioavailability. Mineral oil will alter the absorption of fat-soluble vitamins and reduces the tube light. Others results were found as phenytoin, warfarin, captopril and furosemide with enteral nutrition may reduce the maximum serum concentration. Conclusion: Drug interactions are more common in day-to-day activities than health professionals may suppose. Knowledge on the matter may also assist in reducing cases of obstruction of tubes, through which enteral nutrition and medications are administered. Thus, the multidisciplinary team, acting together, may have more beneficial effects to the patient.

Espaço, memória e identidade no romance o viúvo, de Ronaldo Costa Fernandes

Dissertação (mestrado)—Universidade de Brasília, Instituto de Letras, Programa de Pós-Graduação em Literatura, 2016.

First case reported of Bouveret's syndrome associated to duodenal and biliary perforation to retroperitoneum

We present the case of a 69 year old woman with a history of cholecystitis, who consulted for severe abdominal pain, nausea and vomiting. Abdominal CT showed duodenal obstruction caused by a gallstone, cholecystoduodenal fistula and pneumobilia, what is known as Bouveret's syndrome, a rare form of gallstone ileus. Additionally, she presented free duodenal and vesicular perforation to retroperitoneum at the same level of the cholecystoduodenal transit point. The patient underwent a difficult cholecystectomy, enterolithotomy, repair of the duodenal defect, extensive washing and drainage of the retroperitoneum. The postoperative course was uneventful except for a laparotomy infection.

A inclusão da diversidade linguística no ensino básico na perspectiva de pais e professores : Um estudo de caso no interior rural

É num quadro internacional caracterizado pela crescente multi/interculturalidade das populações escolares, que se inscreve o presente trabalho de investigação, que tem como tema a inclusão da diversidade linguística no ensino básico, no contexto específico da Escola Básica com Jardim-de-infância de Ammaia, situada no interior rural de Portugal, mais precisamente no Alto Alentejo. A pesquisa, alicerçada no paradigma interpretativo, caracterizou-se por uma investigação de cariz qualitativo, mais precisamente um estudo de caso, que teve como principal fonte de recolha de dados as entrevistas em profundidade, realizadas a quatro docentes e a um encarregado de educação imigrante, as quais foram objecto de análise de conteúdo posterior. Entre os objectivos do estudo encontravam-se a identificação de algumas respostas educativas organizadas pelas escolas, no âmbito da sua autonomia, com vista a inclusão dos alunos migrantes e dos principais factores de favorecimento e de obstrução à inclusão dos mesmos, na perspectiva e concepção dos mais directos intervenientes no processo, nomeadamente os professores e os pais ou encarregados de educação destes alunos. Da análise e interpretação dos resultados ficou expresso o esforço que as comunidades educativas vêm fazendo com vista a adaptarem-se à inclusão da multi/interculturalidade, designadamente a linguística, não obstante as dificuldades com que se debatem, tais como a falta de formação da docente e a escassez de recursos para garantir o sucesso destes alunos. Além disso, permitiu comprovar alguns dados apontados pela investigação, nomeadamente a disseminação desta população por todo o território nacional e a generalização da prática denominada por «desclassificação», através da colocação dos alunos em níveis inferiores aos que frequentavam no estrangeiro. Foi igualmente possível apontar alguns dos factores que mais contribuirão para a sua inclusão, dos quais se destaca o estabelecimento de relações afectivas sólidas por parte destes alunos com os seus pares e a necessidade de fazer uso de métodos progressivos e flexíveis, adaptados às necessidades e capacidades dos alunos, capazes de lhes garantirem um nível adequado de proficiência da língua portuguesa, enquanto factor essencial ao seu sucesso educativo. ABSTRACT: It is in an international context, characterized by the growing cultural, ethnical, linguistic diversity and other aspects of school populations, which lead educational communities to severe changes, that the present investigational work refers to, whose topic is the inclusion of language diversity in the basic teaching, in the specific context of Escola Básica com Jardim de Infância de Ammaia, located in the rural interior of Portugal, to be more accurate, in the North Alentejo region. The research, based on the interpretational paradigm, is characterized by a qualitative investigation, more precisely in a case study, which had as a main source of data gathering the interviews done to four teachers and an immigrant parent, which were subjected to posterior content analysis. Among the aims of the study were the identification of some educational responses organized by schools, in the extent of its autonomy, regarding the inclusion of migrant pupils and the main favoring and obstruction factors to the inclusion of these same pupils, in the perspective, conception and comprehension of the most direct intervenient in the process, namely teachers and parents of these pupils. From the analysis and interpretation of the results it is visible the effort educational communities have been making in order to adapt themselves to the inclusion of the multi/interculturality, namely linguistic, in spite of the difficulties they find, such as the lack of formation of teachers and the scarcity of resources to guarantee the success of this new school population. Likewise, it allowed to prove some data pointed out by the investigation, namely the dissemination of this population throughout the national territory and the generalization of the practice called "disqualification”, by placing pupils in inferior levels to those they attended abroad. It was also possible to point out some of the factors that most contribute to their inclusion, of which stand out the establishment of solid affective relationship between these pupils and their peers and the necessity to use progressive and flexible methods, adapted to the needs and capacities of the pupils, able to guarantee an adequate proficiency level of the Portuguese language, as the key factor to their educational success.

Awake examination versus DISE for surgical decision making in patients with OSA: A systematic review

OBJECTIVE: Traditionally, upper airway examination is performed while the patient is awake. However, in the past two decades, drug-induced sleep endoscopy (DISE) has been used as a method of tridimensional evaluation of the upper airway during pharmacologically induced sleep. This study aimed to systematically review the evidence regarding the usefulness of DISE compared with that of traditional awake examination for surgical decision making in patients with obstructive sleep apnea (OSA). DATA SOURCES: Scopus, PubMed, and Cochrane Library databases were searched. REVIEW METHODS: Only studies with a primary objective of evaluating the usefulness of DISE for surgical decision making in patients with OSA were selected. The included studies directly compared awake examination data with DISE outcome data in terms of possible influences on surgical decision making and operation success. RESULTS: A total of eight studies with 535 patients were included in this review. Overall, the surgical treatment changed after DISE in 50.24% (standard deviation 8.4) cases. These changes were more frequently associated with structures contributing to hypopharyngeal or laryngeal obstruction. However, these differences do not automatically indicate a higher success rate. CONCLUSION: This review emphasized the direct impact of DISE compared with that of awake examination on surgical decision making in OSA patients. However, it is also clear that the available published studies lack evidence on the association between this impact and surgical outcomes

Relatório de Estágio

A asma é uma doença crónica das vias respiratórias, normalmente associada a uma hiper- reatividade das vias aéreas e a uma obstrução variável do fluxo de ar. É um problema grave de saúde global e que se encontra associado a vários fatores como o envelhecimento, a pobreza, desemprego e condições de vida insalubres. A adesão ao tratamento é importante para que exista o bom controlo da asma, contribuindo dessa forma para a melhoria na qualidade de vida com redução dos custos associados à doença. A intervenção de uma equipa multidisciplinar, sistematizando conhecimentos em diversas áreas para a prevenção e educação na saúde, promovendo o reforço do poder e da responsabilidade do doente, contribuindo para a melhoria individual e coletiva dentro de um contexto de vida saudável, tem como objetivo incentivar alterações de comportamentos para a melhoria de estilos de vida mais saudáveis. A implementação da consulta de enfermagem surgiu da necessidade em acompanhar doentes com o diagnóstico de asma uma vez que só existe consulta médica. A consulta de enfermagem tem por finalidade reforçar a educação do doente e proporcionar maior segurança e aceitação na adesão e controlo da doença