Who uses NHS saúde 24 hotline? Has the user changed over time?

There has been an increase in the use of telephone-based services and internet throughout the years and, therefore, the Saúde 24 Hotline has become an important service in Portugal. This service aims to screen, counsel and refer the patient in order to avoid unnecessary visits to health institutions and also to indicate the most appropriate resource according to the illness. This work has two different questions: the first one examines the determinants of satisfaction that have more influence on the overall satisfaction of the Saúde 24 Hotline users. The second one aims to analyze if the confidence level of the users is increasing over time, measured by following the recommendation. The first study was conducted on a random sample collected from June to October 2014, which was taken from the User Satisfaction Survey. The second approach includes data from January 2008 to December 2014 from the Clinical Data Base of all users who have called the Hotline. Findings suggest that the majority of users are very satisfied with the service and the variables with more impact on the overall satisfaction are commitment and availability from the nurse, adequacy of call duration and quick identification of the problem. The survey indicates that 94% of respondents follow the recommendation and on average people have called the hotline 3 times in the previous year. The results from the Clinical Database show that people who were recommended to go to the emergency room are more likely to follow the advice than the people who were recommended to book routine appointments

A complete molecular biology assay for hepatitis C virus detection, quantification and genotyping

Introduction Molecular biology procedures to detect, genotype and quantify hepatitis C virus (HCV) RNA in clinical samples have been extensively described. Routine commercial methods for each specific purpose (detection, quantification and genotyping) are also available, all of which are typically based on polymerase chain reaction (PCR) targeting the HCV 5′ untranslated region (5′UTR). This study was performed to develop and validate a complete serial laboratory assay that combines real-time nested reverse transcription-polymerase chain reaction (RT-PCR) and restriction fragment length polymorphism (RFLP) techniques for the complete molecular analysis of HCV (detection, genotyping and viral load) in clinical samples. Methods Published HCV sequences were compared to select specific primers, probe and restriction enzyme sites. An original real-time nested RT-PCR-RFLP assay was then developed and validated to detect, genotype and quantify HCV in plasma samples. Results The real-time nested RT-PCR data were linear and reproducible for HCV analysis in clinical samples. High correlations (> 0.97) were observed between samples with different viral loads and the corresponding read cycle (Ct - Cycle threshold), and this part of the assay had a wide dynamic range of analysis. Additionally, HCV genotypes 1, 2 and 3 were successfully distinguished using the RFLP method. Conclusions A complete serial molecular assay was developed and validated for HCV detection, quantification and genotyping.

Implementation of a zebrafish health program in a research facility : A 4-year retrospective study

In the past two decades, zebrafish (Danio rerio)-based research has contributed to significant scientific advances. Still, husbandry and health programs did not evolve at the same pace, as evidenced by the absence of general guidelines. Health monitoring is essential to animal welfare, to permit animal exchanges across facilities, to contribute to robust experimental results, and for data reproducibility. In this study, we report a health program implemented in a zebrafish research facility to prevent, monitor, and control pathogen, and disease dissemination. This program includes quarantine, routine health screening of sentinels, and nonroutine screenings of retired animals and sick/moribund individuals. An extensive list of clinical signs, lesions, and pathogens was monitored based on: daily observation of fish, necropsy, histology, and bacterial culture. The results indicate that the combined analysis of sentinels with the evaluation of sick/moribund animals enables a comprehensive description not only of pathogen prevalence but also of clinical and histopathologic lesions of resident animals. The establishment of a quarantine program revealed to be effective in the reduction of Pseudoloma neurophilia frequency in the main aquaria room. Finally, characterization of the colony health status based on this multiapproach program shows a low prevalence of lesions and pathogens in the facility.

Monoterpene isolated from the essential oil of Trachyspermum ammi is cytotoxic to multidrug-resistant Pseudomonas aeruginosa and Staphylococcus aureus strains

Abstract INTRODUCTION: The aim of this study was to determine whether an herbal extract containing monoterpene exhibited activity against multidrug-resistant Staphylococcus aureus and Pseudomonas aeruginosa isolated from clinical infection samples. METHODS: The essential oil of Trachyspermum ammi (L.) Sprague ex Turrill (Apiaceae) fruit was extracted by hydrodistillation. Fruit residues were treated with hydrochloric acid and re-hydrodistilled to obtain volatile compounds. Compounds in the distilled oil were identified using gas-chromatography (GC) and GC-mass spectrometry (MS). The antibiotic susceptibility of all bacterial isolates was analyzed using both the disc diffusion method and determination of the minimum inhibitory concentration (MIC). The sensitivity of antibiotic-resistant isolates to essential oil was also determined by using the disc diffusion method and MIC determination. RESULTS: Of 26 clinical isolates, 92% were multidrug-resistant (MDR). Aromatic monoterpenes (thymol, paracymene, and gamma-terpinene) were the major (90%) components of the oil. Growth of S. aureus strains was successfully inhibited by the oil, with an inhibitory zone diameter (IZD) between 30-60mm and MIC <0.02μL/mL. The oil had no antimicrobial activity against clinical isolates of P. aeruginosa; rather, it prevented pigment production in these isolates. CONCLUSIONS: This study revealed that the essential oil of Trachyspermum ammi, which contains monoterpene, has good antibacterial potency. Monoterpenes could thus be incorporated into antimicrobial ointment formulas in order to treat highly drug-resistant S. aureus infections. Our findings also underscore the utility of research on natural products in order to combat bacterial multidrug resistance.

Helicobacter pylori genotyping from positive clotests in patients with duodenal ulcer

Even though the seroprevalence of H. pylori may be high in the normal population, a minority develops peptic ulcer. Colonization of the gastric mucosa by more pathogenic vacA strains of H. pylori seems to be associated with enhanced gastric inflammation and duodenal ulcer. H. pylori genotyping from positive CLOtests was developed to determine the vacA genotypes and cagA status in 40 duodenal ulcer patients and for routine use. The pathogenic s1b/ m1/ cagA genotype was the most frequently occurring strain (17/42.5%); only two (5%) patients presented the s2/ m2 genotype, the less virulent strain. Multiple strains were also detected in 17 (42.5%) patients. Multiple strains of H. pylori colonizing the human stomach have been underestimated, because genotyping has been performed from cultures of H. pylori. We concluded that genotyping of H. pylori from a positive CLOtest had the advantages of reducing the number of biopsies taken during endoscopy, eliminating the step of culturing H. pylori, and assuring the presence of H. pylori in the specimen being processed.

Cost of drugs manufactured by the University Hospital - role of the Central Pharmacy

The hospital pharmacy in large and advanced institutions has evolved from a simple storage and distribution unit into a highly specialized manipulation and dispensation center, responsible for the handling of hundreds of clinical requests, many of them unique and not obtainable from commercial companies. It was therefore quite natural that in many environments, a manufacturing service was gradually established, to cater to both conventional and extraordinary demands of the medical staff. That was the case of Hospital das Clinicas, where multiple categories of drugs are routinely produced inside the pharmacy. However, cost-containment imperatives dictate that such activities be reassessed in the light of their efficiency and essentiality. METHODS: In a prospective study, the output of the Manufacturing Service of the Central Pharmacy during a 12-month period was documented and classified into three types. Group I comprised drugs similar to commercially distributed products, Group II included exclusive formulations for routine consumption, and Group III dealt with special demands related to clinical investigations. RESULTS: Findings for the three categories indicated that these groups represented 34.4%, 45.3%, and 20.3% of total manufacture orders, respectively. Costs of production were assessed and compared with market prices for Group 1 preparations, indicating savings of 63.5%. When applied to the other groups, for which direct equivalent in market value did not exist, these results would suggest total yearly savings of over 5 100 000 US dollars. Even considering that these calculations leave out many components of cost, notably those concerning marketing and distribution, it might still be concluded that at least part of the savings achieved were real. CONCLUSIONS: The observed savings, allied with the convenience and reliability with which the Central Pharmacy performed its obligations, support the contention that internal manufacture of pharmaceutical formulations was a cost-effective alternative in the described setting.

Agenesis of the posterior arch of the atlas

PURPOSE: To illustrate the radiological findings and review the current literature concerning a rare congenital abnormality of the posterior arch of the atlas. CASE REPORT: An adult female without neurological symptoms presented with an absent posterior arch of the atlas, examined with plain films and helical computerized tomography. Complete agenesis of the posterior arch of the atlas is a rare entity that can be easily identified by means of plain films. Although it is generally asymptomatic, atlantoaxial instability and neurological deficits may occur because of structural instability. Computerized tomography provides a means of assessing the extent of this abnormality and can help evaluate the integrity of neural structures. Although considered to be rare entities, defects of the posterior arch of the atlas may be discovered as incidental asymptomatic findings in routine cervical radiographs. Familiarity with this abnormality may aid medical professionals in the correct management of these cases.

Filtros em barragens de aterro: caracterização da sua permeabilidade

A determinação do coeficiente de permeabilidade de filtros de barragens de aterro é feita com a aplicação de equações empíricas. Dado que estas equações variam com o índice de vazios, a sua aplicação a um mesmo filtro, pode originar variações do coeficiente de permeabilidade, consoante o valor de índice de vazios que lhe é atribuído. Neste trabalho é feita uma análise, aplicando diferentes formulas empíricas devidamente selecionadas a dois filtros construídos para o controlo do movimento de partículas e analisam-se os resultados obtidos. Os dois filtros são ainda sujeitos a ensaios de permeabilidade em laboratório com uso do permeâmetro de parede rígida a carga constante, variando o seu índice de vazios, de modo a perceber qual das equações adotadas melhor se adequa aos resultados obtidos no laboratório. Por fim, é feita uma análise da estabilidade hidráulica de uma barragem de aterro zonada, modelada com base num programa de elementos finitos, da qual fazem parte um filtro chaminé e um filtro horizontal, aos quais se aplicou uma gama de coeficientes de permeabilidade inserida nos resultados obtidos nas equações anteriores.

Critical analysis of old and new vaccines against N. meningitidis serogroup C, considering the meningococcal disease epidemiology in Brazil

Worldwide, the impact of meningococcal disease is substantial, and the potential for the introduction and spread of more virulent strains of N. meningitidis or strains with increased resistance to current antibiotics causes concern, making prevention essential. OBJECTIVES: Review the indications for meningococcal disease vaccines, considering the epidemiological status in Brazil. METHODS: A critical literature review on this issue using the Medline and Lilacs databases. RESULTS: In Brazil, MenB and MenC were the most important serogroups identified in the 1990s. Polysaccharide vaccines available against those serogroups can offer only limited protection for infants, the group at highest risk for meningococcal disease. Additionally, polysaccharide vaccines may induce a hypo-responsive state to MenC. New meningococcal C conjugate vaccines could partially solve these problems, but it is unlikely that in the next few years a vaccine against MenB that can promote good protection against multiple strains of MenB responsible for endemic and epidemic diseases will become available. CONCLUSIONS: In order to make the best decision about recommendations on immunization practices, better quality surveillance data are required. In Brazil, MenC was responsible for about 2,000 cases per year during the last 10 years. New conjugate vaccines against MenC are very effective and immunogenic, and they should be recommended, especially for children less than 5 years old. Polysaccharide vaccines should be indicated only in epidemic situations and for high-risk groups. Until new vaccines against MenC and MenB are available for routine immunization programs, the most important measure for controlling meningococcal disease is early diagnosis of these infections in order to treat patients and to offer chemoprophylaxis to contacts.

Vaccines in pregnancy: a review of their importance in Brazil

Neonates and young children remain susceptible to many serious infectious diseases preventable through vaccination. In general, current vaccines strategies to prevent infectious diseases are unable to induce protective levels of antibodies in the first 6 months of life. Women vaccinated during pregnancy are capable of producing immunoglobulin antibodies that are transported actively to the fetus, and maternal immunization can benefit both the mother and the child. With few exceptions, maternal immunization is not a routine, because of the concerns related to the safety of this intervention. Ethical and cultural issues make the studies on maternal immunization difficult; however, in the last decade, the development of new vaccines, which are very immunogenic and safe has reactivated the discussions on maternal immunization. In this paper we present a review of the literature about maternal immunization based on MEDLINE data (1990 to 2002). The most important conclusions are: 1) there is no evidence of risk to the fetus by immunizing pregnant women with toxoids, polysaccharide, polysaccharide conjugated and inactive viral vaccines; 2) most viral attenuated vaccines are probably safe too, but data is still insufficient to demonstrate their safety; therefore these vaccines should be avoided in pregnant women; 3) in Brazil, there is a need for a maternal immunization program against tetanus. Many new candidate vaccines for maternal immunization are available, but studies should be conducted to evaluate their safety and efficacy, as well as regional priorities based on epidemiological data.

Retrospective evaluation of bone pain palliation after samarium-153-EDTMP therapy

PURPOSE: The aim of this study was to evaluate the degree of metastatic bone pain palliation and medullar toxicity associated with samarium-153-EDTMP treatment. METHODS: Seventy-three patients with metastatic bone pain having previously undergone therapy with samarium-153-EDTMP (1 mCi/kg) were retrospectively evaluated. Routine follow-up included pain evaluation and blood counts for 2 months after treatment. Pain was evaluated using a subjective scale (from 0 to 10) before and for 8 weeks after the treatment. Blood counts were obtained before treatment and once a week for 2 months during follow-up. Dosimetry, based upon the urinary excretion of the isotope, was estimated in 41 individuals, and the resulting radiation absorbed doses were correlated with hematological data. RESULTS: Reduction in pain scores of 75% to 100% was obtained in 36 patients (49%), with a decrease of 50% to 75%, 25% to 50%, and 0% to 25% in, respectively, 20 (27%), 10 (14%), and 7 (10%) patients. There was no significant relationship between the pain response and location of the primary tumor (breast or prostate cancer). Mild to moderate myelosuppression was noted in 75.3% of patients, usually with hematological recovery at 8 weeks. The mean bone marrow dose was 347 ± 65 cGy, and only a weak correlation was found between absorbed dose and myelosuppression (Pearson coefficient = .4). CONCLUSIONS: Samarium-153-EDTMP is a valuable method for metastatic bone pain palliation. A mild to moderate and transitory myelosuppression is the main toxicity observed after samarium therapy, showing a weak correlation with dosimetric measures.

Versão portuguesa do CANE (Camberwell Assessment of Need for the Elderly) : desenvolvimento e dados preliminares

RESUMO - A avaliação de necessidades de cuidados é crucial no planeamento, monitorização e avaliação de serviços de psiquiatria e saúde mental, bem como na investigação e na clínica. Este princípio é obviamente aplicável aos serviços responsáveis por populações de pessoas mais velhas. O instrumento CANE — Camberwell Assessment of Need for the Elderly possibilita uma avaliação consistente das necessidades de utentes idosos, nomeadamente em situações de patologia neuropsiquiátrica. Procede-se a uma avaliação cruzada, entrevistando a pessoa em questão, o seu cuidador informal e o técnico responsável. Esta avaliação multidimensional abrange domínios da esfera biológica, psicológica e social, sendo aplicável na comunidade ou em internamento (regime parcial ou completo). A utilidade do CANE tem sido evidenciada em contextos clínicos, de investigação e de avaliação de serviços. Existem múltiplas traduções a nível internacional, a maioria das quais validada. Na área da epidemiologia psiquiátrica nem sempre estão disponíveis os dados relativos à qualidade das adaptações de instrumentos, pelo que se apresenta o processo de desenvolvimento da versão portuguesa (de acordo com as regras para validação transcultural, no processo de tradução-retroversão). A aplicabilidade da versão portuguesa foi satisfatória neste estudo-piloto, representando a primeira fase de um trabalho multicêntrico nacional. Nesta fase inicial, foram considerados casos de idosos com patologia neuropsiquiátrica (maioritariamente demência — 71,4%), em dois centros (Lisboa e Porto) (n = 21). A média de idades foi 73,9 (± 6,3) anos, sendo 76,2% do sexo feminino. A maioria vivia em casa, apresentava co-morbilidade somática e estava em contacto com um cuidador informal (em geral, familiares do sexo feminino). Os avaliadores identificaram necessidades, nem sempre cobertas, nas seguintes dimensões: cuidados com a casa, alimentação, actividades diárias, memória, saúde física, sofrimento psicológico, companhia e dinheiro/economias. Nem sempre a perspectiva de doentes, cuidadores, técnicos e avaliadores foi inteiramente coincidente. Estes resultados preliminares da aplicação da versão portuguesa do CANE são consistentes quanto à sua validade ecológica, facial e de conteúdo, estando em curso contributos adicionais para a validação efectiva numa amostra de maior dimensão.

Gestão de crises de âmbito policial

The issues concerning Crisis Situations under the scope of police activity, raised after incidents considered critical, has emerged with greater intensity during the most recent decades, posing a major challenge for police forces around the world. These are situations or events of crucial importance, involving hostage taken or barricaded individuals, in which inevitably human lives are at risk, requiring from law enforcement agencies a specific response capability, i.e., a type of intervention not framed under the parameters considered as routine, in order to obtain solutions to minimize the possibility of casualties. Because this is about impacting situations of extreme gravity, where the preservation of human lives is concerned and, in many cases, the very Rule of Law as well, we understand the need for police forces to adapt to new procedures and working methods. Such procedures are an enormously complex task that requires the coordination and articulation of several components, including not infrequently the performance of different police forces, as well as organizations and entities with varied powers and duties, which implies the need for effective management. This explains the emergence of Crisis Management Structures, imposing to determine which are their fundamental components, their importance, how they interconnect, and their major goal. The intrinsic features will also be analyzed in the aspect that we consider to be the fundamental groundwork of a Crisis Management Structure, i.e., Negotiation itself, considering it as a kind of police intervention, where a wide range of procedures feeds a channel of dialogue, aiming at minimizing the damage resultant from an extreme action, in particular, to prevent the death of any of those involved. This is in essence the path we have chosen to develop this study, trying to find out an answer to the fundamental question: What model of Crisis Management Structure should be adopted to manage a critical event involving hostage negotiation?

Otimização da anisotropia fronto-calosa e ressonância magnética [1,5T] no idoso normal e com risco cérebro-vascular

RESUMO: Os mais recentes métodos de neuro imagem tal como a Ressonância Magnética (RM) permitiram obter imagens detalhadas do cérebro humano in vivo. Essas imagens revelam, muitas vezes, achados imprevistos face ao padrão normal, com elevada propensão para os indivíduos idosos e franca coexistência com fatores de risco vascular, como característica dum processo de envelhecimento normal. Embora na última década tenham surgido várias publicações sobre este assunto, ele continua ainda pouco explicado. Um pouco por todo o mundo têm emergido os programas de prevenção da doença e promoção da saúde desenvolvidos pela Saúde Pública suportadas sobretudo pelo avanço das tecnologias médicas que resultaram, entre outros impactos, num crescimento da população idosa. Estima-se, em 2030, uma composição demográfica com 20% de indivíduos acima dos 65 anos. Neste contexto, a doença microvascular cerebral é a causa mais frequente de comprometimento cognitivo vascular no idoso sendo as características senescentes na imagem por RM do tipo lesões isquémicas da Substância Branca (Leukoaraiosis) e enfartes lacunares (Status lacunar), atrofia cerebral, gliose e acumulação excessiva de ferro nos núcleos da base. Esta tese, considerando a linha de investigação de que deriva – Ciências da Vida - especialização em Medicina Clinica - Biotecnologia, reúne e reflete sobre três vertentes ligadas à RM e interdependentes em relação a uma problemática comum. A primeira trata da caracterização da Tecnologia por Ressonância Magnética existente em Portugal, a qual inclui uma avaliação exploratória da aplicação da técnica de Difusão Anisotrópica nos estudos cerebrais. As dimensões analíticas estudadas foram a Tecnológica, Sociodemográfica e Económica. Na recolha de dados recorreu-se a várias fontes de informação e a uma metodologia exploratória faseada, validada pela triangulação dos resultados. A sua análise obedeceu a critérios de estratificação e agrupamento segundo as mesmas dimensões analíticas. Otimização da anisotropia fronto-calosa e [RM 1,5T] no idoso normal e com risco cérebro-vascular A segunda descreve o estudo anátomo – radiológico que recaiu sobre parâmetros de quantificação assente na temática do cérebro do idoso em cadáver segundo uma metodologia experimental aplicada às métricas da difusão por RM. Na terceira, e última, é apresentado o estudo técnico - radiológico para avaliação e otimização da imagem ponderada em difusão em estudos clínicos associados ao cérebro do idoso “The Usual Brain Aging” ou Envelhecimento Cerebral Normal, com base metodológica assente nos critérios e indicadores estabelecidos pelo Estudo de Imagem de Roterdão (Rotterdam Scan Study - RSS). Como principais resultados obteve-se que não existem em Portugal estruturas para avaliação dos equipamentos pesados ou Agência de Avaliação das Tecnologias da Saúde para desenvolver o importante papel da produção de estudos comparativos entre os equipamentos disponíveis no mercado, a relação preço-qualidade e a sua afetação às necessidades clínico-epidemiológicas. Constatou-se que a implementação de equipamentos de RM está fortemente assente em critérios económicos carecendo de recomendações e diretivas para o uso racionalizado destas tecnologias. Quanto a dados quantitativos concluímos que a maioria dos equipamentos está instalada em instituições privadas (80,2%); a intensidade de campo magnético mais frequente é [1,5T] com 119 equipamentos; os equipamentos estão instalados maioritariamente nos distritos de Lisboa (55 unidades) e do Porto (39 unidades); o rácio médio de equipamentos por habitante em Portugal é de 1 para 65 195 habitantes; a amplitude de gradientes com maior expressão na amostra é 30-39mT/m; a maioria dos equipamentos foi instalada no intervalo temporal [2009-2012] com 59 equipamentos; apenas 6 instituições desenvolvem investigação clinica e a maioria das bobinas para estudos de crânio são do tipo Array. O estudo de otimização da técnica da difusão revelou, quanto à avaliação dos valoresb, que os mais baixos (b=500 s/mm2 e b=1000 s/mm2), apresentam maior IS e SNR sendo esta uma boa medida referente à qualidade de imagem, no entanto, os valores-b mais elevados (b=2000 s/mm2) apresentam maior CNR e CR, face aos anteriores, o Otimização da anisotropia fronto-calosa e [RM 1,5T] no idoso normal e com risco cérebro-vascular que apesar de proporcionar inferior detalhe anatómico e consequentemente inferior qualidade de imagem, num encéfalo normal, pode auxiliar na interpretação e apresentar vantagens na identificação de lesões microvasculares sempre que persistirem dúvidas em relação ao diagnóstico diferencial de doença microvascular do tipo status lacunar ou Hiperintensidades da Substância Branca. As alterações deste parâmetro são particularmente refletidas nas diferenças da avaliação da qualidade de imagem na região fronto-calos Concluímos da avaliação quantitativa da concentração média de ferro (26Fe) em todas as faixas etárias que os núcleos da base que apresentam maior concentração são, por ordem decrescente: Substância Nigra, Globus Pallidus, Putamen, Tálamo, Núcleo Rubro e Núcleo Caudado; que existe uma predominância na concentração de ferro (26Fe) no hemisfério esquerdo e que os indivíduos do género masculino apresentam mais ferro (26Fe) que os do género feminino nas faixas etárias [30-40[, [40-50[ e [50-60[. Como principal conclusão do estudo da concentração média de ferro em relação à idade destacamos que a concentração média de ferro (26Fe) é superior nos grupos etários superiores, logo aumenta com a idade, sobretudo na Substância Nigra e no Núcleo Lenticular. No estudo técnico-radiológico encontrámos evidências do aumento da difusibilidade da água na substância branca subcortical dos sujeitos idosos comparativamente aos mais jovens. Uma relação idêntica foi avaliada nos tálamos. O aumento relacionado com a idade parece ser predominantemente observado em doentes com mais de 65 anos de idade o que pode refletir alterações estruturais ligeiras associados ao envelhecimento normal. Os resultados indicam que a análise quantitativa das imagens ponderadas em difusão fornece informações, sobre a estrutura do cérebro, as quai s não estão disponíveis apenas por inspeção visual, tanto nas imagens ponderadas em difusão como em outras sequências de aplicação clínica de rotina. Para fazer face às desvantagens dos sistemas de quantificação das HSB os quais são dispendiosos, complexos, requererem tecnologia e formação específicas, recomendamos que a aplicação automatizada GUIAL, desenvolvida ao longo do nosso trabalho é de utilização elementar e prática para que seja introduzida nos sistemas de aquisição de imagem por RM com o fim de integrar o processamento de imagem nos indivíduos portadores de fatores de risco vascular. A avaliação do ADC, nesta amostra, permitiu concluir que a variação desta variável é explicada estatisticamente pela existência da condição clínica de status lacunar em ambos os hemisférios ou por outras palavras, o status lacunar influencia o valor de ADC. Embora uma pequena percentagem da variação do ADC seja explicada pelo género, o ADC nos homens foi superior ao das mulheres o que não nos surpreende, pois são também os homens onde a frequência de doença microvascular se revelou mais expressiva. Os valores do ADC, globalmente, entre os hemisférios cerebrais não mostraram alterações exceto na SB entre os idosos e não idosos. A SB da região frontal mostrou valores diminuídos na anisotropia e isotropia face às restantes áreas anatómicas. Os estudos indicam que na idade avançada existe uma maior predisposição para suscetibilidades de estrutura com status de desconexão. A classificação das HSB foi superior em indivíduos mais velhos e com status lacunar, e em menor quantidade (inferior rating de classificação) nos indivíduos idosos sem status lacunar. As alterações volumétricas foram mais frequentes no homem do que na mulher, presumivelmente devido à associação com a elevada classificação de status lacunar. Um aumento do índice de Evan correspondeu, neste estudo, ao aumento das HSB, à diminuição do volume cerebral total, à expansão ventrículo-sulcal frontal e ao aumento da medida do ângulo caloso. Estes resultados foram agravados pela classificação elevada de status lacunar nos indivíduos que apresentaram indícios de doença de pequenos vasos, com manifesto aumento dos espaços de Virchow-Robin,enfartes lacunares ou HSB. Esses resultados foram mais expressivos no género masculino do que no feminino revelando uma maior vulnerabilidade sobretudo na atrofia frontal nos homens. Por sua vez as dimensões do Corpo Caloso tornaram-se reduzidas devido à compressão dos ventrículos laterais e terceiro ventrículo. Estes indicadores tiveram expressão particularmente nos indivíduos com mais de 65 anos. ---------------------------------------------------------------------------------------------ABSTRACT: The latest neuroimaging methods, such as Magnetic Resonance Imaging (MRI), have enabled detailed images of in vivo human brain. These images reveal often unexpected findings related to the normal pattern, with high predisposition for the elderly people with forthright coexistence with vascular risk factors such as characteristics of a normal aging process. Although it has been, in the last decade, several publications on this subject, it is still little explained. All over the world have emerged disease prevention programs and health promotion developed by the Public Health sector, supported mainly by the advancement of medical technologies that have resulted, among other impacts, in a growing of the elderly population. It is estimated, in 2030, a demographic composition with 20% o people over 65 years. In this context, microvascular disease is the most common cause of cognitive vascular impairment in the elderly and senescent characteristics in the MRI trough ischemic lesions of the white matter (Leukoaraiosis) and lacunar infarcts (lacunar status), cerebral atrophy, gliosis and iron accumulation in the basal ganglia in excess.This thesis, considering the research line that stems - Life Sciences - specialization in Clinical Medicine, Biotechnology, gathers and reflects on three aspects linked to MR, interdependent and related to a common problem. The first deals with the Magnetic Resonance Technology characterization in Portugal, which includes an exploratory evaluation of the implementation of Anisotropic Diffusion technique in brain studies. The analytical dimensions studied were the Technologic, Socio-demographic and Economics. Collecting data was supported by different sources of information and was applied an exploratory methodology whose results were validated by triangulation. The research method was grouped and stratified criteria under the same analytical dimensions. The second describes the anatomical study - which was focused on radiological measurement parameters, based on the brain’s specimen under an experimental methodology applied to MRI diffusion metrics. Radiological evaluation and optimization of the weighted image diffusion in clinical studies were associated with the brain of the elderly "The Usual Brain Aging" with methodological basis based on established criteria and indicators by Rotterdam Scan Study (RSS). The main results obtained reveal the inexistence frameworks in Portugal for evaluation of equipments or Agency of Health Technology to produce studies comparing the equipment available on the market, the value for money and its allocation to clinical and epidemiological needs. It was found that the implementation of MRI equipment is strongly based on economic criteria lacking recommendations and guidelines for the rationalized use of these technologies. As the quantitative data we conclude that most of the scanners are located in private clinical institutions (80,2%); the most frequent magnetic field intensity is [1.5T] with 119 scanners; the scanners are mainly installed in Lisbon (55 units) and Porto (39 units) districts; the average ratio of equipment per capita in Portugal is 1 to 65 195 people; the gradient power with higher expression in the sample is 30-39mT / m;most of the scanners were installed in the years range [2009-2012 years] with 59 equipment; only 6 clinical placements develop clinical research and the most coils for brain studies are of Array type. The optimization study of diffusion technique revealed, as the assessment of the bvalues, the lower (b = 500 s / mm2 and b = 1000 s / mm 2), promotes an increase in the SI and SNR being this measure related to a higher image quality, however the highest b values (b = 2000 s / mm 2) have a higher CNR (Contrast to Noise-Ratio) and CR (Contrast Ratio), compared to the previous ones. This may provide less anatomical details and, thus, ower image quality, of a normal brain, however can help the interpretation and have advantages in identifying microvascular injuries when doubts persist regarding the differential diagnosis of microvascular disease of lacunar or WMH (White Matter Hyperintensities) status type. Changes on this parameter are Otimização da anisotropia fronto-calosa e [RM 1,5T] no idoso normal e com risco cérebro-vascular particularly reflected in the differences of image quality evaluation in the frontocallosum anatomical area. We conclude from the quantitative assessment of the average concentration of iron (26Fe), in all age groups to the basal ganglia, that the higher concentrations are, in descending order: Nigral Substantia, Globus pallidus, Putamen, Thalamus, Rubio nucleus and Caudate nucleus; that there is a predominance in the concentration of iron (26Fe) in the left hemisphere and that male gender show higher iron (26Fe) level tha females, in the age groups [30-40 [[40-50 [and [50- 60 [. Regarding a main conclusion of the mean concentration study of iron, in terms of age we point out that the average concentration of iron (26Fe) is higher among older groups and increases with age, especially in Nigral Substantia and Lenticular Nucleus. On the technical and radiological study we found evidence of an increased in water /diffusivity in the ubcortical white matter of the elderly compared with younger subjects. A similar relationship was assessed in the Thalamus. The increase agerelated seems to be predominantly observed in patients over 65 years which may reflect minor structural changes associated with normal aging. The results indicate that quantitative analysis of diffusion weighted imaging can provide information about the structure of the brain which is not reached only by visual inspection or standard sequences applied in clinical routine. To address the disadvantages the systems of quantification of WMH which the authors state that are costly, complex, require specific technology and training, we recommend that the automated application GUIAL, developed over our work is basic and practical to use and to be introduced in MR image systems acquisition in order to integrate image processing in patients with vascular risk factors. The evaluation of the ADC showed that its variation is statistically explained by the existence of the medical condition of lacunar status, in both hemispheres, or in other words, the lacunar status influences the ADC value. Although a small percentage of the ADC variation is explained by gender, the ADC in men was higher than women which Otimização da anisotropia fronto-calosa e [RM 1,5T] no idoso normal e com risco cérebro-vascular do not surprise us, since they are also men where the frequency of microvasculardisease has proved more significant. The values of ADC, overall, between the cerebral hemispheres showed no changes but were different in WM among the elderly and non-elderly subjects.The WM's forehead showed decreased values in anisotropy and isotropy face the other anatomical areas. The studies indicate that in old age there is a greater tendency to higher susceptibility to disconnection- status framework. The classification of WMH was higher in elderly people and lacunar status, and fewer (lower classification rating) in the elderly without lacunar status. volumetric changes were more frequent in men than in women, most probably because of its association with high lacunar status rating. An increase of Evan index corresponded, in this study, to an increase in WMH, to a decreased of total brain volume, to a ventricle sulcal frontal and callous angle expansion. These results were wound up by high ranking of lacunar status in subjects who had small vessel disease, clear increase in spaces of Virchow-Robin, lacunar infarctions or WMH. These results were more significant in males than in females revealing vulnerability particularly in the frontal atrophy in men. In turn the size of Corpus Callosum because reduced due to the compression of the lateral and third ventricles. These indicators had expression particularly in individuals over 65 years.

Uma ferramenta para cálculo da máxima intensidade da ilha de calor noturna

O objetivo deste artigo é verificar a influência da geometria urbana na intensidade de ilhas de calor noturnas com uso de uma ferramenta computacional desenvolvida como extensão de um SIG. O método deste trabalho está dividido em três principais etapas: desenvolvimento da ferramenta, calibração do modelo e simulação de cenários hipotéticos com diferentes geometrias urbanas. Um modelo simplificado que relaciona as intensidades máximas de ilha de calor urbana (ICUmáx) com a geometria urbana foi incorporado à subrotina de cálculo e, posteriormente, adaptado para fornecer resultados mais aproximados à realidade de duas cidades brasileiras, as quais serviram de base para a calibração do modelo. A comparação entre dados reais e simulados mostraram uma diferença no aumento da ICUmáx em função da relação H/W e da faixa de comprimento de rugosidade (Z0). Com a ferramenta já calibrada, foi realizada uma simulação de diferentes cenários urbanos, demonstrando que o modelo simplificado original subestima valores de ICUmáx para as configurações de cânions urbanos de Z0 < 2,0 e superestima valores de ICUmáx para as configurações de cânions urbanos de Z0 ≥ 2,0. Além disso, este estudo traz como contribuição à verificação de que cânions urbanos com maiores áreas de fachadas e com alturas de edificações mais heterogêneas resultam em ICUmáx menores em relação aos cânions mais homogêneos e com maiores áreas médias ocupadas pelas edificações, para um mesmo valor de relação H/W. Essa diferença pode ser explicada pelos diferentes efeitos na turbulência dos ventos e nas áreas sombreadas provocados pela geometria urbana.