Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

PURPOSE: This study was designed to compare baseline data and clinical outcome between patients with prostate enlargement/benign prostatic hyperplasia (PE/BPH) who underwent unilateral and bilateral prostatic arterial embolization (PAE) for the relief of lower urinary tract symptoms (LUTS). METHODS: This single-center, ambispective cohort study compared 122 consecutive patients (mean age 66.7 years) with unilateral versus bilateral PAE from March 2009 to December 2011. Selective PAE was performed with 100- and 200-μm nonspherical polyvinyl alcohol (PVA) particles by a unilateral femoral approach. RESULTS: Bilateral PAE was performed in 103 (84.4 %) patients (group A). The remaining 19 (15.6 %) patients underwent unilateral PAE (group B). Mean follow-up time was 6.7 months in group A and 7.3 months in group B. Mean prostate volume, PSA, International prostate symptom score/quality of life (IPSS/QoL) and post-void residual volume (PVR) reduction, and peak flow rate (Qmax) improvement were 19.4 mL, 1.68 ng/mL, 11.8/2.0 points, 32.9 mL, and 3.9 mL/s in group A and 11.5 mL, 1.98 ng/mL, 8.9/1.4 points, 53.8 mL, and 4.58 mL/s in group B. Poor clinical outcome was observed in 24.3 % of patients from group A and 47.4 % from group B (p = 0.04). CONCLUSIONS: PAE is a safe and effective technique that can induce 48 % improvement in the IPSS score and a prostate volume reduction of 19 %, with good clinical outcome in up to 75 % of treated patients. Bilateral PAE seems to lead to better clinical results; however, up to 50 % of patients after unilateral PAE may have a good clinical outcome.

Efeitos de um Programa de Reabilitação Respiratória em Indivíduos Operados a Cancro do Pulmão

O tratamento cirúrgico e os tratamentos coadjuvantes do cancro do pulmão de não pequenas células (CPNPC), como a quimioterapia, afetam negativamente a saúde física e psicológica dos pacientes. Um programa de reabilitação respiratória (PRR) pode ajudar no controlo de sintomas, melhorar a capacidade funcional e a qualidade de vida desta população. Objetivo: verificar a influência de um programa de reabilitação respiratória composto por fisioterapia torácica, treino aeróbio, treino de força e educação para a saúde, em parâmetros como a qualidade de vida, a ansiedade e depressão, a dispneia, a capacidade funcional para realizar exercício e a força muscular, em 6 doentes operados a CPNPC. Métodos: estudo retrospetivo, do tipo série de estudos de caso, que incluiu 6 casos clínicos. As medidas de resultados utilizadas foram: qualidade de vida; dispneia; ansiedade e depressão; capacidade funcional para a marcha; e força muscular. Resultados: no final do PRR, os 6 participantes apresentaram melhoria nos níveis de qualidade de vida, uma diminuição nos valores de ansiedade e depressão e um grau de dispneia inferior ao avaliado inicialmente. Foi ainda verificado um aumento da capacidade funcional para o exercício e da força muscular em todos os casos clínicos. Conclusão: O PRR pareceu produzir efeitos positivos na diminuição dos sintomas, assim como melhorou a qualidade de vida, a capacidade funcional para a marcha e a força muscular dos 6 participantes.

Escleroterapia do Varicocelo da Veia Ovárica: Resultados a Curto e Longo Prazo

Purpose: To evaluate the safety and efficiency of sclerotherapy in ovarian vein varicocele. Study population: During 6 years, 36 women with the clinical diagnosis of ovarian vein varicocele were evaluated. Methods: The diagnosis was confirmed by flebography of the ovarian vein in 35 of the patients. In these patients sclerotherapy of the ovarian vein was performed with success by selective retrograde catheterization of the ovarian vein by femoral approach in 31 patients and by brachial approach in 4 patients. Four to eight ml of polidocanol l3% was used in each vein. Results: There was clinical improvement with complete resolution of all symptoms in 29 patients(82.9%) and partial symptomatic relief in 6 (17.1%). Long term results, evaluated between 1 and 6 years (mean 37.3 months), showed complete resolution of symptoms in 27 (77.1%) and recurrence in 8 (22.9%). Four patients with recurrence, improved following repeated sclerotherapy. Thus, there was long term improvement in 31 patients (88.6%). Conclusion: Sclerotherapy of ovarian vein appears to be a safe and efficient treatment of ovarian vein varicocele.

Perdas por imparidade em intangíveis

Dissertação de Mestrado apresentado ao Instituto de Contabilidade e Administração do Porto para a obtenção do grau de Mestre em Contabilidade e Finanças, sob orientação do Doutor Carlos Quelhas Martins

Management of Childhood Urticaria: Current Knowledge and Practical Recommendations

Urticaria, defined by the presence of wheals and/or angioedema,is a common condition in children, prompting parents to consult physicians. For its successful management, paediatric-specific features must be taken into account, regarding the identification of eliciting triggers and pharmacological therapy. This review systematically discusses the current best-available evidence on spontaneous acute and chronic urticaria as well as physical and other urticaria types in children. Potential underlying causes, namely infections, food and drug hypersensitivity, autoreactivity and autoimmune or other conditions, and eliciting stimuli are considered, with practical recommendations for specific diagnostic approaches. Second-generation antihistamines are the mainstay of pharmacological treatment aimed at relief of symptoms, which require dose adjustment for paediatric use. Other therapeutic interventions are also discussed. In addition, unmet needs are highlighted, aiming to promote research into the paediatric population, ultimately aiming at the effective management of childhood urticaria.

Integration of crowdsourced information with traditional crises and disaster management information using linked data

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

A Web based geospatial application for disaster preparedness in Uganda

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

IDENTIFICATION OF SANDFLIES (Diptera: Psychodidae: Phlebotominae) BLOOD MEALS IN AN ENDEMIC LEISHMANIASIS AREA IN BRAZIL

SUMMARY The aim of this study was to identify blood meals of female sandflies captured in the municipality of Governador Valadares, an endemic area of visceral and cutaneous leishmaniasis, in the State of Minas Gerais, Brazil. From May 2011 to January 2012, captures were performed using HP light traps in four districts. There were 2,614 specimens (2,090 males and 524 females) captured; 97 engorged females were identified belonging to the species Lutzomyia longipalpis (82.1%) and Lutzomyia cortelezzii (17.9%). Considering simple and mixed feeding, the enzyme-linked immunosorbent assay revealed a predominance of chicken blood (43.6%) in Lutzomyia longipalpis, showing the important role that chickens exert around the residential areas of Governador Valadares. This finding increases the chances of sandflies contact with other vertebrates and consequently the risk of leishmaniasis transmission.

IgG4-Related Hashimoto's Thyroiditis - A New Variant of a Well Known Disease

Hashimoto's thyroiditis (HT) has been characterized for many years as a well-defined clinicopathologic entity, but is now considered a heterogeneous disease. IgG4-related HT is a new subtype characterized by thyroid inflammation rich in IgG4-positive plasma cells and marked fibrosis. It may be part of the systemic IgG4-related disease. We report a case of a 56-year-old Portuguese man who presented with a one-month history of progressive neck swelling and dysphagia. Laboratory testing revealed increased inflammatory parameters, subclinical hypothyroidism and very high levels of thyroid autoantibodies. Cervical ultrasound (US) demonstrated an enlarged and heterogeneous thyroid gland and two hypoechoic nodules. US-guided fine needle aspiration cytology was consistent with lymphocytic thyroiditis. The patient was submitted to total thyroidectomy and microscopic examination identified typical findings of HT, marked fibrosis limited within the thyroid capsule and lymphoplasmacytic infiltration, with >50 IgG4-positive plasma cells per high-power field and an IgG4/IgG ratio of >40%. After surgery, serum IgG4 concentration was high-normal. Symptoms relief and reduction in laboratory inflammatory parameters were noticed. Thyroid function is controlled with levothyroxine. To our knowledge we report the first case of IgG4-related HT in a non-Asian patient. We also perform a review of the literature regarding IgG4-related disease and IgG4-related HT. Our case highlights this new variant of the well known HT, and helps physicians in recognizing its main clinical features, allowing for proper diagnosis and treatment.

Levantamento epidemiológico e virológico de casos suspeitos de poliomielite no Hospital Estadual Jesus, no período de janeiro de 1967 a março de 1968

Os autores apresentam os resultados de isolamento de poliovírus de crianças com suspeita de poliomielite paralítica no Isolamento do Hospital Estadual Jesus do Estado da Guanabara. Nas 188 amostras computadas apresentaram-se 79 positivas, destas 73,5% de poliovírus tipo I, 25,3% do tipo II e 1,2% do tipo III. Os autores mostram no Gráfico 1, um aumento da incidência da poliomielite a partir dos últimos meses no ano de 1967. Chamam a atenção para o grande número de casos no grupo etário de 0-3 anos (Gráfico 2); colocam ainda em questão o melhor equacionamento do problema das vacinações (Tabela 1), com estudos laboratoriais de avaliação da vacina Sabin. O estudo da procedência e sexo das crianças não permitiu maiores conclusões, sendo levantada também a relação da idade com a incidência da poliomielite (Tabela 2), bem como a necessidade de se realizar estudos para outros enterovírus, presentes na população infantil da área estudada.

Efetividade da intervenção conservadora e de um programa de exercício físico no solo na osteoartrose do joelho

RESUMO: Objectivo: O estudo do efeito da fisioterapia e do exercício em diversos indicadores relacionados com a osteoartrose do joelho tem evidenciado efeitos benéficos em utentes com esta condição. Nesta sequência, pretendeu-se avaliar a efetividade da intervenção conservadora em conjunto com um programa de exercícios ao nível da dor, rigidez, amplitude articular, função física e qualidade de vida em utentes com osteoatrose do joelho a curto prazo, quando comparado com a intervenção recomendada. A prática clínica atual em Portugal, sob prescrição, desenvolve-se de acordo com o padrão que se pretende investigar. Metodologia: Trata-se de um estudo quasi-experimental controlado e sem aleatorização. Os utentes da Clínica FPM (n=20; 35,0% homens, 65,0% mulheres) sujeitos à intervenção conservadora (calor húmido, ultra-som e massagem) em conjunto com um programa de exercício no solo, durante um período de 4 semanas com frequência diária, integram o grupo experimental e os utentes inscritos no programa de exercício a solo do “Viver Activo” no Leirisport (n=21; 23,8% homens, 76,2% mulheres), num período de 8 semanas com frequência bi-semanal são considerados como grupo de controlo. Os instrumentos de medida aplicados foram o Knee Outcome Osteoarthritis Score (KOOS) para os outcomes dor, rigidez, função física e qualidade de vida e a goniometria para a amplitude articular. Resultados: Em ambos os grupos foram observados aumentos significativos em todos os outcomes avaliados pelo KOOS (dor, rigidez, função física e qualidade de vida) e pela goniometria (amplitude articular) num período de 4 e 8 semanas. Quando comparada a evolução do grupo experimental com a do grupo controlo, verifica-se que as diferenças significativas ocorrem na flexão (p <0,05) (maior evolução para o grupo experimental), e na dor (p <0,05) (maior evolução para o grupo controlo). Nos outcomes rigidez, função física e qualidade de vida foi ainda possível identificar resultados positivos que sugerem possíveis benefícios da intervenção em grupo para os sujeitos a ela submetidos. Discussão e Conclusão: Estes resultados sugerem que a intervenção clínica individualizada é mais efectiva do que a intervenção em grupo no aumento da amplitude articular do joelho em utentes com osteoartrose a curto prazo. No entanto, para os outcomes dor, rigidez, função física e qualidade de vida, a intervenção em grupo parece ser clinicamente e estatisticamente melhor. A relevância deste estudo afirma-se ao demonstrar que utentes com osteoartrose do joelho que integrem um programa de exercício em grupo beneficiam de melhorias importantes. Ao adicionar sessões de fisioterapia para realização de intervenção conservadora individualizada e exercícios supervisionados agrega um maior alívio sintomático.-------- ABSTRACT: Study of physical therapy and exercise into several indicators associated to knee osteoarthritis has shown positive effects in subjects within this condition. According to the study it has been evaluated the effectiveness of a conservative intervention along with a exercise program directed to pain, stiffness, range of motion, physical function and quality of life of patients with knee osteoarthritis in a short term when compared with the recommended intervention. Under prescription the current clinical practice in Portugal is developed according to the pattern to investigate. Methodology: This is a quasi-experimental controlled study without randomization. The subjects of FPM Clinic (n= 20, 35.0% men, 65.0% women) were submitted to the conservative intervention (hot pack, ultrasound and massage) with a land exercise program during a 4 week-period (all-weekly) were assigned in the experimental group. Patients signed in the land exercise program of "Active Living" in Leirisport (n = 21, 23.8% men, 76.2% women) a 8 week-period (bi-weekly) were assigned as control group. Outcomes were measured by the Knee Outcome Osteoarthritis Score (KOOS) for pain, stiffness, physical function and quality of life. Goniometry was used for range of motion. Results: Both treatment groups obtained successful outcomes measured by significant reductions in KOOS scores and improvement in goniometry in a 4 and 8-week period. When compared the evolution of the experimental group with the control group it appears that significant differences occur in the range of motion (p <0.05) (further progress in the experimental group), and pain (p <0.05) (further evolution for the control group). In outcomes stiffness, physical function and quality of life was possible to identify positive results that suggest potential benefits of intervention for the submitted subjects. Discussion and Conclusion: These results suggest that individualized clinical intervention is more effective than group intervention in range of motion improving in patients with knee osteoarthritis in a 4-week period. However outcomes for pain, stiffness, physical function and quality of life appear to be clinically and statistically better for the group intervention. The significance of this study is essencial because it demonstrates that patients with knee osteoarthritis who incorporate an exercise program in group reveal improvements. When adding physical therapy sessions with individual conservative intervention and supervised exercises the result is an improvement of symptomatic relief.

Globalisation et gouvernance tous azimuts

Ce titre s’inscrit dans le thème de Braga de Macedo et al. (2013c): globalisation, démocratie et développement. La section 2 discute les intéractions complexes entre globalisation, gouvernance et développement d’un côté et entre réformes et élections de l’autre. La section 3 introduit la « differentialité » des pays et son rapport avec le multilatéralisme basé sur la culture d’un côté et la pression par les pairs de l’autre. La section 4 quantifie les interactions positives et négatives en distinguant les pays de l’OCDE des pays en développement. La section 5 avance que ces résultats permettront de mettre à jour les perceptions des économistes sur la crise, peut être sous la forme d’une lettre à la reine, utilisée par des économistes britanniques mais élargie aux pays lusophones.

Integrated approach to assess vulnerability of the Coastal Region of Bangladesh due to climate change

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.

Draft for a Mental Health strategy Lebanon

RESUMO: O Líbano é um pequeno país na costa leste do Mar Mediterrâneo, com uma população de aproximadamente 4.350.000 pessoas, incluindo 1,5 milhões de refugiados, 400 mil dos quais são palestinos atendidos pela UNRWA (Agência das Nações Unidas de Socorro aos Refugiados da Palestina) (UNHCR, 2013; OMS, 2010a). Desde 2012, um excedente de 1.000.000 refugiados sírios cruzaram a fronteira com o Líbano, representando um aumento populacional de aproximadamente 25%. Além disso, entre 1975 e 1990, a violenta guerra civil pela qual o Líbano passou, destruiu grande parte da infra-estrutura do país, incluindo os serviços de saúde. O sector da saúde, mais especificamente os serviços de saúde mental, é majoritariamente privado. Serviços especializados em Saúde Mental estão disponíveis em três hospitais psiquiátricos privados, e em 4 unidades psiquiátricas de hospitais gerais, que estão localizados centralmente em torno da capital, Beirute. O Líbano é um dos dois únicos países da região que não tem uma Política de Saúde Mental e um dos seis países que não têm uma Legislação em Saúde Mental. Nos últimos anos, a Saúde Mental está sendo colocada no topo da agenda nacional, apesar das contínuas questões políticas e de segurança. Baseando-se nas informações acima, um projecto de estratégia em Saúde Mental, conduzido pelo Ministério da Saúde e apoiado pela OMS, foi escrito para servir como um guia para trabalhar em diferentes aspectos relacionados tanto em saúde mental quanto em organização dos serviços, revisão de legislação, financiamento e proteção dos direitos humanos básicos dos usuários do serviço. Esta tese descreve o processo pelo qual o projecto de estratégia nacional de Saúde Mental foi desenvolvido, seus principais componentes, os próximos passos a serem tomados para a sua implementação, os desafios e as oportunidades para implementá-lo e propõe alguns passos iniciais a serem tomados em primeiro lugar.----------ABSTRACT: Lebanon is a small country on the eastern shore of the Mediterranean Sea with a population of approximately 4,350,000 including 1,500,000 refugees, 400,000 of whom are Palestinians served by UNRWA (the United Nations Relief and Works Agency for Palestine Refugees) (UNHCR, 2013; WHO, 2010a). Since 2012 an excess of 1,000,000 Syrian refugees have crossed the border into Lebanon accounting for approximately 25% increase in the population. In addition, from 1975 to 1990 Lebanon underwent a violent civil war that had also destroyed much of the country infrastructure including health services. The health sector, more so the mental health services, is mostly private. Specialized Mental Health services are available at three private mental hospitals, and 4 psychiatric units within general hospitals, which are located centrally around the capital, Beirut. Lebanon is one of only two countries of the region that does not have a Mental Health policy and one out of the six countries that does not have a Mental Health legislation. In recent years, Mental Health is getting placed higher on the national agenda despite the ever continuing political and security issues. Based on the above, A Mental Health strategy draft, lead by the Ministry of Health and supported by WHO, was written to serve as a guide to work on different aspects related to Mental Health from service organization, to the revision of legislation, financing and the protection of the basic human rights of service users. This thesis describes the process through which the national Mental Health draft strategy was developed, its main components, the next steps to be taken for its implementation, the challenges and the opportunities to implementing it and proposes a few initial steps to be taken first.

A intervenção dos orgãos de polícia criminal em sede de julgamento

Currently, Portugal assumes itself as a democratic rule of substantive law State, sustained by a legal system seeking the right balance between the guarantee of fundamental rights and freedoms constitutional foreseen in Portugal’s Fundamental Law and criminal persecution. The architecture of the penal code lies with, roughly speaking, a accusatory basic structure, “deliberately attached to one of the most remarkable achievements of the civilizational democratic progress, and by obedience to the constitutional commandment”, in balance with the official investigation principle, valid both for the purpose of prosecution and trial. Regarding the principle of non self-incrimination - nemo tenetur se ipsum accusare, briefly defined as the defendant’s right of not being obliged to contribute to the self-incrimination, it should be stressed that there isn’t an explicit consecration in the Portuguese Constitution, being commonly accepted in an implicit constitutional prediction and deriving from other constitutional rights and principles, first and foremost, the meaning and scope of the concept of democratic rule of Law State, embedded in the Fundamental Law, and in the guidelines of the constitutional principles of human person dignity, freedom of action and the presumption of innocence. In any case, about the (in) applicability of the principle of the prohibition of self-incrimination to the Criminal Police Bodies in the trial hearing in Court, and sharing an idea of Guedes Valente, the truth is that the exercise of criminal action must tread a transparent path and non-compliant with methods to obtain evidence that violate the law, the public order or in violation of democratic principles and loyalty (Guedes Valente, 2013, p. 484). Within the framework of the penal process relating to the trial, which is assumed as the true phase of the process, the witness represents a relevant figure for the administration of criminal justice, for the testimonial proof is, in the idea of Othmar Jauernig, the worst proof of evidence, but also being the most frequent (Jauernig, 1998, p. 289). As coadjutant of the Public Prosecutor and, in specific cases, the investigating judge, the Criminal Police Bodies are invested with high responsibility, being "the arms and eyes of Judicial Authorities in pursuing the criminal investigation..." which has as ultimate goal the fulfillment of the Law pursuing the defense of society" (Guedes Valente, 2013, p. 485). It is in this context and as a witness that, throughout operational career, the Criminal Police Bodies are required to be at the trial hearing and clarify the Court with its view about the facts relating to occurrences of criminal context, thus contributing very significantly and, in some cases, decisively for the proper administration of the portuguese criminal justice. With regards to the intervention of Criminal Police Bodies in the trial hearing in Court, it’s important that they pay attention to a set of standards concerning the preparation of the testimony, the very provision of the testimony and, also, to its conclusion. Be emphasized that these guidelines may become crucial for the quality of the police testimony at the trial hearing, thus leading to an improvement of the enforcement of justice system. In this vein, while preparing the testimony, the Criminal Police Bodies must present itself in court with proper clothing, to read before and carefully the case files, to debate the facts being judged with other Criminal Police Bodies and prepare potential questions. Later, while giving his testimony during the trial, the Criminal Police Bodies must, summing up, to take the oath in a convincing manner, to feel comfortable, to start well by convincingly answering the first question, keep an attitude of serenity, to adopt an attitude of collaboration, to avoid the reading of documents, to demonstrate deference and seriousness before the judicial operators, to use simple and objective language, to adopt a fluent speech, to use nonverbal language correctly, to avoid spontaneity responding only to what is asked, to report only the truth, to avoid hesitations and contradictions, to be impartial and to maintain eye contact with the judge. Finally, at the conclusion of the testimony, the Criminal Police Bodies should rise in a smooth manner, avoiding to show relief, resentment or satisfaction, leaving a credible and professional image and, without much formality, requesting the judge permission to leave the courtroom. As final note, it’s important to stress that "The intervention of the Police Criminal Bodies in the trial hearing in Court” encloses itself on a theme of crucial importance not only for members of the Police and Security Forces, who must welcome this subject with the utmost seriousness and professionalism, but also for the proper administration of the criminal justice system in Portugal.