OCCUPATIONAL EXPOSURES TO BODY FLUIDS AND BEHAVIORS REGARDING THEIR PREVENTION AND POST-EXPOSURE AMONG MEDICAL AND NURSING STUDENTS AT A BRAZILIAN PUBLIC UNIVERSITY

A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in “standard precautions” to prevent such exposures.

Stress-Related Mucosal Disease: Incidence of Bleeding and the Role of Omeprazole in its Prophylaxis

BACKGROUND: Upper gastrointestinal bleeding is the severe complication of stress-related mucosal disease in hospitalized patients. In intensive care units (ICU), risk factors are well defined and only mechanical ventilation and coagulopathy proved to be relevant for significant bleeding. On the contrary, in non-ICU settings there is no consensus about this issue. Nevertheless, omeprazole is still widely used in prophylaxis of bleeding. The objective of our study was to evaluate the relevance of stress-related mucosal disease bleeding in patients admitted to an internal medicine ward, and the role of omeprazole in its prophylaxis. METHODS: We conducted a retrospective study in which we analysed consecutive patients who were admitted to our ward over a year. We recorded demographic characteristics of the patients, potential risk factors for stress-related mucosal disease (clinical data, laboratory, and medication), administration of prophylactic omeprazole, and total cost of this prophylaxis. Patients with active gastrointestinal bleeding on the admission were excluded. We recorded every upper gastrointestinal bleeding event with clinical relevance. RESULTS: Five hundred and thirty-five patients, mean age 70 years, mean length of stay 9.6+/-7.7 days; 140 (26.2%) patients were treated with 40 mg of omeprazole intravenously, 193 (36.1%) with 20mg of omeprazole orally, and 202 (37.8%) patients had no prophylaxis. There was only one episode (0.2%) of clinically relevant bleeding. CONCLUSION: In patients admitted to an internal medicine ward, incidence of upper gastrointestinal bleeding as a complication of stress-related mucosal disease is low. We found that there is no advantage in prophylaxis with omeprazole.

Ambulatory Hysteroscopy Results Post-Menopause: Comparative Study Between Patients With and Without Metrorrhagia

Our objective was to compare the results of ambulatory hysteroscopy in postmenopausal women with and without uterine bleeding. A retrospective descriptive study was carried out on 236 women who were at least 2 years into the menopause, who were not undergoing hormone treatment and who had had abnormal pelvic ultrasound results. Of these women, 150 were asymptomatic and 86 reported haemorrhage. Diagnostic and operative outpatient hysteroscopy was performed between January 2002 and December 2003. There was no difference between the two groups regarding age of patients, age of menopause and presence of at least one of the risk factors for endometrial carcinoma evaluated, although obesity was more frequent in the symptomatic group. Abnormal ultrasound results for these women corresponded in the majority of cases to intracavitary disease, and the absence of organic endometrial pathology was 9.3% vs 11.3% in each group. The more frequent pathology was benign endometrial polyps (64% in bleeding patients and 84.7% in asymptomatic ones). Endometrial carcinoma was diagnosed in 23.3% of women with metrorrhagia and in 1.3% of asymptomatic women. We diagnosed 2.6% of malignancy inside polyps. Hysteroscopy results were confirmed by histology in 90.3% of cases. See and treat in one session was achieved in 91% of benign endometrial polyps. Ambulatory hysteroscopy has high sensitivity and specificity for intracavitary pathology and high tolerability and safety. See and treat in one session can be achieved in the majority of lesions with indication for excision. These results make us advise our menopausal patients with abnormal uterine bleeding to undergo diagnostic hysteroscopy complemented with biopsy.

Regulation of autoimmune neuroinflammation by stress-responsive genes

Dissertation presented to obtain the Ph.D degree in Biology

Epidemiological studies of Streptococcus pneumoniae carriage in the post-vaccination era among two risk groups: children and the elderly

Dissertation presented to obtain the Ph.D. degree in Biology/ Molecular Biology

The Role of Psychological Adjustment in the Decision-Making Process for Voluntary Termination of Pregnancy

BACKGROUND: This study's objective was to evaluate the role of psychological adjustment in the decision-making process to have an abortion and explore individual variables that might influence this decision. METHODS: In this cross-sectional study, we sequentially enrolled 150 women who made the decision to voluntarily terminate a pregnancy in Maternity Dr. Alfredo da Costa, in Lisbon, Portugal, between September 2008 and June 2009. The instruments were the Depression, Anxiety and Stress Scale (DASS), Satisfaction with Social Support Scale (SSSS), Emotional Assessment Scale (EAS), Decision Conflict Scale (DCS), and Beliefs and Values Questionnaire (BVQ). We analyzed the data using Student's T-tests, MANOVA, ANOVA, Tukey's post-hoc tests and CATPCA. Statistically significant effects were accepted for p<0.05. RESULTS: The participants found the decision difficult and emotionally demanding, although they also identified it as a low conflict decision. The prevailing emotions were sadness, fear and stress; but despite these feelings, the participants remained psychologically adjusted in the moment they decided to have an abortion. The resolution to terminate the pregnancy was essentially shared with supportive people and it was mostly motivated by socio-economic issues. The different beliefs and values found in this sample, and their possible associations are discussed. CONCLUSION: Despite high levels of stress, the women were psychologically adjusted at the time of making the decision to terminate the pregnancy. However, opposing what has been previously reported, the women presented high levels of sadness and fear, showing that this decision was hard to make, triggering disruptive emotions.

Infecções post-transfusionais por Plasmodium falciparum

Os autores fazem breve revisão sôbre o período de duração da infecção pelo P. falciparum, citando casos em que êsse período atingiu até 3 anos, sob forma latente. Referem-se ao risco que êsse fato representa através transfusões de sangue e finalmente relatam 3 casos em que julgam ter ocorrido essa situação que poderá ter conseqüências gravíssimas: 1. Pela possibilidade de ser transfundida uma raça de P. falciparum resistente aos diferentes anti-maláricos. 2. Pelo fato de serem as transfusões de sangue feitas de um modo geral em pacientes com condições áébilitantes as mais diversas. 3. Pela dificuldade com que se defrontam os técnicos em transfusão na detectação do parasito resistente ou não em casos assintomáticos. 4. Pela difusão relativamente significativa de raças de P. falciparum resistentes, a vários pontos do território nacional.

Contraceptive Choices Pre and Post Pregnancy in Adolescence

STUDY OBJECTIVE: The main aim of this study is to evaluate the impact of adolescent pregnancy in the future contraceptive choices. A secondary aim is to verify whether these choices differ from those made after an abortion. DESIGN: Retrospective study. SETTING:Adolescent Unit of a tertiary care center. PARTICIPANTS:212 pregnant teenagers. INTERVENTIONS: Medical records review. MAIN OUTCOME MEASURES:Intended pregnancy rate and contraceptive methods used before and after pregnancy. For contraceptive choices after pregnancy we considered: Group 1 - teenagers who continued their pregnancy to delivery (n = 106) and Group 2 - the same number of adolescents who chose to terminate their pregnancy. RESULTS: The intended pregnancy rate was 14.2%. Prior to a pregnancy continued to delivery, the most widely used contraceptive method was the male condom (50.9%), followed by oral combined contraceptives (28.3%); 18.9% of adolescents were not using any contraceptive method. After pregnancy, contraceptive implant was chosen by 70.8% of subjects (P < .001) and the oral combined contraceptives remained the second most frequent option (17.9%, P = .058). Comparing these results with Group 2, we found that the outcome of the pregnancy was the main factor in the choices that were made. Thus, after a pregnancy continued to delivery, adolescents prefer the use of LARC [78.4% vs 40.5%, OR: 5,958 - 95% (2.914-12.181), P < .001)], especially contraceptive implants [70.8% vs 38.7%, OR: 4.371 - 95% (2.224-8.591), P < .001], to oral combined contraceptives [17.9% vs 57.5%, OR: 0.118 - 95% CI (0.054-0.258), P < .001]. CONCLUSION:Adolescent pregnancy and its outcome constitute a factor of change in future contraceptive choice.

Women's Attachment as a Predictor of Pain During Labour and Post-Delivery: a Prospective Observational Study

INTRODUCTION: Labour is considered to be one of the most painful and significant experiences in a woman's life. The aim of this study was to examine whether women's attachment style is a predictor of the pain experienced throughout labour and post-delivery. MATERIAL AND METHODS:Thirty-two pregnant women were assessed during the third trimester of pregnancy and during labour. Adult attachment was assessed with the Adult Attachment Scale ' Revised. The perceived intensity of labour pain was measured using a visual analogue scale for pain in the early stage of labour, throughout labour and post-delivery. RESULTS:Women with an insecure attachment style reported more pain at 3 cm of cervical dilatation (p < 0.05), before the administration of analgesia (p < 0.01) and post-delivery (p < 0.05) than those securely attached. In multivariate models, attachment style was a significant predictor of labour pain at 3 cm of cervical dilatation and before the first administration of analgesia but not of the perceived pain post-delivery. DISCUSSION: These findings confirm that labour pain is influenced by relevant psychological factors and suggest that a woman's attachment style may be a risk factor for greater pain during labour. CONCLUSION:Future studies in the context of obstetric pain may consider the attachment style as an indicator of individual differences in the pain response during labour. This may have important implications in anaesthesiology and to promote a relevant shift in institutional practices and therapeutic procedures.

A Case of Post-Radiotherapy Gastritis: Radiation Does Not Explain Everything

Hemorrhagic gastritis is a possible late toxicity outcome after radical radiotherapy but it is nowadays a very rare condition and most likely depends on other clinical factors. We report the case of a 77-year-old woman with a symptomatic solitary extramedullary intra-abdominal plasmacytoma and multiple gastric comorbidities, treated with external beam radiotherapy. Despite the good response to radiotherapy, the patient experienced multiple gastric bleeding a few months later, with the need of multiple treatments for its control. In this paper we will discuss in detail all aspects related to the different causes of hemorrhagic gastritis.

Post-Treated Prostate Cancer: Normal Findings and Signs of Local Relapse on Multiparametric Magnetic Resonance Imaging

The use of multiparametric magnetic resonance imaging (mp-MRI) for prostate cancer has increased over recent years, mainly for detection, staging, and active surveillance. However, suspicion of recurrence in the set of biochemical failure is becoming a significant reason for clinicians to request mp-MRI. Radiologists should be able to recognize the normal post-treatment MRI findings. Fibrosis and atrophic remnant seminal vesicles after prostatectomy are often found and must be differentiated from local relapse. Moreover, brachytherapy, external beam radiotherapy, cryosurgery, and hormonal therapy tend to diffusely decrease the signal intensity of the peripheral zone on T2-weighted images (T2WI) due to the loss of water content, consequently mimicking tumor and hemorrhage. The combination of T2WI and functional studies like diffusion-weighted imaging and dynamic contrast-enhanced improves the identification of local relapse. Tumor recurrence tends to restrict on diffusion images and avidly enhances after contrast administration either within or outside the gland. The authors provide a pictorial review of the normal findings and the signs of local tumor relapse after radical prostatectomy, external beam radiotherapy, brachytherapy, cryosurgery, and hormonal therapy.

Stress relacionado com o trabalho e burnout em técnicos de radiologia

RESUMO - O fenómeno stress relacionado com o trabalho é um tema atual, bastante debatido e alvo de diversas investigações. No entanto, os estudos portugueses sobre o stress relacionado com o trabalho em profissionais de saúde não são muito frequentes, apesar de desempenharem uma atividade considerada de alto risco em termos de stress. O síndrome de burnout é a consequência de prolongados níveis de stress relacionado com o trabalho e compreende três dimensões: exaustão emocional (EE), despersonalização (DSP) e realização pessoal (RP). O presente estudo demonstra-se como não experimental, descritivo e transversal que pretende contribuir para uma melhor compreensão do stress relacionado com o trabalho e burnout em técnicos de radiologia. Estudaram-se 73 técnicos de radiologia do Centro Hospitalar de Lisboa Central. 76,4% da população em estudo é do sexo feminino, 58,9% tem idades compreendidas entre os 41 e 60 anos, 53,4% dos profissionais são casados e 56,1% tem entre 1 e 20 anos de serviço como técnico de radiologia nos locais em estudo. Foram utilizados três questionários, um sócio-demográfico, o questionário Perceived Stress Scale (versão portuguesa do Instituto de Prevenção do Stress e Saúde Ocupacional) e o questionário Maslach Burnout Inventory (versão portuguesa traduzida pela Drª Alexandra Pinto. Verifica-se que 50,7% dos profissionais em estudo percecionam o seu nível de stress relacionado com o trabalho como elevado. Na análise da perceção do stress relacionado com o trabalho, foram os homens que surgiram com um nível mais elevado, assim como os profissionais dos 20 aos 40 anos, os solteiros e aqueles com um tempo de serviço entre 1 e 20 anos. Em relação ao burnout verificamos que 66,2% da população em estudo apresenta nível médio a elevado de EE, 57,9% de DSP e 66,2% de RP. Podemos verificar que são as mulheres que surgem com valores mais elevados de EE e RP, enquanto os homens apresentam valores mais elevados na dimensão DSP. Os mais novos (20 a 40 anos) e os solteiros apresentam nível médio a elevado de EE e DSP, enquanto os mais velhos (41 aos 60 anos) e os casados demonstram níveis mais elevados de RP. Estes dados demonstram um nível médio a elevado de burnout vivenciado pelos técnicos de radiologia dos hospitais em estudo.

Iron Overload in a Murine Model of Hereditary Hemochromatosis Is Associated with Accelerated Progression of Osteoarthritis Under Mechanical Stress

OBJECTIVE: Hereditary hemochromatosis (HH) is a disease caused by mutations in the Hfe gene characterised by systemic iron overload and associated with an increased prevalence of osteoarthritis (OA) but the role of iron overload in the development of OA is still undefined. To further understand the molecular mechanisms involved we have used a murine model of HH and studied the progression of experimental OA under mechanical stress. DESIGN: OA was surgically induced in the knee joints of 10-week-old C57BL6 (wild-type) mice and Hfe-KO mice. OA progression was assessed using histology, micro CT, gene expression and immunohistochemistry at 8 weeks after surgery. RESULTS: Hfe-KO mice showed a systemic iron overload and an increased iron accumulation in the knee synovial membrane following surgery. The histological OA score was significantly higher in the Hfe-KO mice at 8 weeks after surgery. Micro CT study of the proximal tibia revealed increased subchondral bone volume and increased trabecular thickness. Gene expression and immunohistochemical analysis showed a significant increase in the expression of matrix metallopeptidase 3 (MMP-3) in the joints of Hfe-KO mice compared with control mice at 8 weeks after surgery. CONCLUSIONS: HH was associated with an accelerated development of OA in mice. Our findings suggest that synovial iron overload has a definite role in the progression of HH-related OA

Proteomic and Transcriptomic Approaches to Abiotic Stress Tolerance in Rice (Oryza sativaL.)

Dissertação para a obtenção de grau de doutor em Biologia pelo Instituto de Tecnologia Química e Biológica da Universidade Nova de Lisboa