Nonacid reflux episodes reaching the pharynx are important factors associated with cough.

Gastroesophageal reflux is implicated in the pathogenesis of asthma and chronic cough. To date most studies have focused on acid reflux measured by pH below the upper esophageal sphincter (UES). The aim of this study was to assess the relationship between cough and reflux through the UES into the pharynx. Methods: Thirty-seven patients with asthma (19) and chronic cough (18) were recruited from the respiratory clinic. Reflux was monitored using a combined multichannel intraluminal impedance and pH probe by detecting (1) bolus reflux episodes within the esophagus and in the pharynx and (2) acidic reflux episodes within the esophagus and in the pharynx. All acid suppressive therapy was stopped for at least 7 days before the study. Demonstration of cough being linked to reflux was achieved using the symptom association probability (SAP). This was calculated using a 2-minute association window between symptoms and bolus entry into the esophagus. SAP was considered positive if >95%. Results: A positive SAP for cough was noted in 7/26 patients reporting symptoms on the day of monitoring. Compared with SAP-negative patients, SAP-positive patients had both a greater number [median (interquartile range), 5(2 to 8) vs. 2(0 to 4), P

Catheter-related bloodstream infection in adult haematology patients:Catheter removal practice and outcome

The aim of the present study was to describe the practice of central venous catheter (CVC) removal and outcomes of catheter-related bloodstream infection (CR-BSI) in adult haematology patients. Patients were identified retrospectively according to diagnosis coding of inpatient episodes and evaluated when, on examination of medical records, there had been evidence of sepsis with strong clinical suspicion that the source was the CVC. Demographic and bacteriological data, as well as therapeutic measures and clinical outcomes, were recorded. One hundred and three patient episodes were evaluated. The most frequent type of CVC was the Hickman catheter and the most frequently isolated pathogen was coagulase-negative staphylococci. Twenty-five percent of episodes were managed with catheter removal. Treatment failure, defined as recurrence of infection within 90 days or mortality attributed to sepsis within 30 days, occurred significantly more frequently in the group managed without catheter removal (52.5% versus 4%, P

Pseudomonas aeruginosa exhibits frequent recombination, but only a limited association between genotype and ecological setting

Pseudomonas aeruginosa is an opportunistic pathogen and an important cause of infection, particularly amongst cystic fibrosis (CF) patients. While specific strains capable of patient-to-patient transmission are known, many infections appear to be caused by unique and unrelated strains. There is a need to understand the relationship between strains capable of colonising the CF lung and the broader set of P. aeruginosa isolates found in natural environments. Here we report the results of a multilocus sequence typing (MLST)-based study designed to understand the genetic diversity and population structure of an extensive regional sample of P. aeruginosa isolates from South East Queensland, Australia. The analysis is based on 501 P. aeruginosa isolates obtained from environmental, animal and human (CF and non-CF) sources with particular emphasis on isolates from the Lower Brisbane River and isolates from CF patients obtained from the same geographical region. Overall, MLST identified 274 different sequence types, of which 53 were shared between one or more ecological settings. Our analysis revealed a limited association between genotype and environment and evidence of frequent recombination. We also found that genetic diversity of P. aeruginosa in Queensland, Australia was indistinguishable from that of the global P. aeruginosa population. Several CF strains were encountered frequently in multiple ecological settings; however, the most frequently encountered CF strains were confined to CF patients. Overall, our data confirm a non-clonal epidemic structure and indicate that most CF strains are a random sample of the broader P. aeruginosa population. The increased abundance of some CF strains in different geographical regions is a likely product of chance colonisation events followed by adaptation to the CF lung and horizontal transmission among patients.

Characterisation of the frequent exacerbator phenotype in COPD patients in a large UK primary care population

BACKGROUND: The 'frequent exacerbator' is recognised as an important phenotype in COPD. Current understanding about this phenotype comes from prospective longitudinal clinical trials in secondary/tertiary care with little information reported in primary care populations.

AIMS: To characterize the frequent-exacerbator phenotype and identify associated risk factors in a large UK primary care COPD population.

METHODS: Using a large database of primary care patients from 80 UK general practices, patients were categorised using GOLD 2014 criteria into high and low risk groups based on exacerbation history. A multivariate logistic regression model was used to investigate covariates associated with the frequent-exacerbator phenotype and risk of experiencing a severe exacerbation (leading to hospitalisation).

RESULTS: Of the total study population (n = 9219), 2612 (28%) fulfilled the criteria for high risk frequent-exacerbators. Independent risk factors (adjusted odds ratio [95% CI]) for ≥2 exacerbations were: most severely impaired modified Medical Research Council (mMRC) dyspnoea score (mMRC grade 4: 4.37 [2.64-7.23]), lower FEV1 percent predicted (FEV1 <30%: 2.42 [1.61-3.65]), co-morbid cardiovascular disease (1.42 [1.19-1.68]), depression (1.56 [1.22-1.99]) or osteoporosis (1.54 [1.19-2.01]), and female gender (1.20 [1.01-1.43]). Older patients (≥75 years), those with most severe lung impairment (FEV1 <30%), those with highest mMRC score and those with co-morbid osteoporosis were identified as most at risk of experiencing exacerbations requiring hospitalisation.

CONCLUSIONS: Although COPD exacerbations occur across all grades of disease severity, female patients with high dyspnoea scores, more severely impaired lung function and co-morbidities are at greatest risk. Elderly patients, with severely impaired lung function, high mMRC scores and osteoporosis are associated with experience of severe exacerbations requiring hospitalisation.

ThermoSpots to detect hypothermia in children with severe acute malnutrition

INTRODUCTION: Hypothermia is a risk factor for increased mortality in children with severe acute malnutrition (SAM). Yet frequent temperature measurement remains unfeasible in under-resourced units in developing countries. ThermoSpot is a continuous temperature monitoring sticker designed originally for neonates. When applied to skin, its liquid crystals are designed to turn black with hypothermia and remain green with normothermia.

AIMS: To (i) estimate the diagnostic accuracy of ThermoSpots for detecting WHO-defined hypothermia (core temperature <35.5°C or peripheral temperature <35.0°C) in children with SAM and (ii) determine their acceptability amongst mothers.

METHODS: Children with SAM in a malnutrition unit in Malawi were enrolled during March-July 2010. The sensitivity and specificity of ThermoSpots were calculated by comparing the device colour against 'gold standard' rectal temperatures taken on admission and follow up peripheral temperatures taken until discharge. Guardians completed a questionnaire to assess acceptability.

RESULTS: Hypothermia was uncommon amongst the 162 children enrolled. ThermoSpot successfully detected the one rectal temperature and two peripheral temperatures recorded that met the WHO definition of hypothermia. Overall, 3/846 (0.35%) temperature measurements were in the WHO-defined hypothermia range. Interpreting the brown transition colour (between black and green) as hypothermia improved sensitivities. For milder hypothermia definitions, sensitivities declined (<35.4°C, 50.0%; <35.9°C, 39.2%). Specificity was consistently above 94%. From questionnaires, 40/43 (93%) mothers reported they were 90-100% happy with the device overall. Free-text answers revealed themes of "Skin Rashes", "User-satisfaction" and "Empowerment".

CONCLUSION: Although hypothermia was uncommon in this study, ThermoSpots successfully detected these episodes in malnourished children and were acceptable to mothers. Research in settings where hypothermia is common is needed to determine performance with certainty. Instructing users to act when the device's transition colour appears could improve accuracy. If reliable, ThermoSpots may offer simple, acceptable and continuous temperature measurement for high-burden areas and reduce the workload of over-stretched staff.

Characterizing Human Cysticercosis In Portugal

Abstract text Introduction: Cysticercosis results from the ingestion Taenia solium eggs directly by faecal-oral route or contaminated food or water. While, still considered a leading cause of acquired epilepsy in developed countries, this zoonosis has been controlled or eradicated in industrialized countries due to significant improvements in sanitation, pig rearing and slaughterhouse control systems. Objectives: the health burden of human cysticercosis in Portugal. Material and Metodes: We developed a retrospective study on human neurocysticercosis (NCC) hospitalisations based on the national database resulting from National Health Service (NHS) hospital episodes except those of Madeira and Azores Islands. Results: Between 2006 and 2013 there were 357 hospitalized NCC cases in Portugal. Annual frequency of cases between 2006-2013 kept stable (mean 45). NCC was most frequent in those aged 25-34 years (59; 16,5%) and those >75 years (65; 18,2%). Overall, mean age was 47,3 years (median age 45, standard deviation 41,1, mode 28) and 176 cases were in males (49,3%); no significant differences were observed between age and gender (t-student, p>0,05). In Norte Region cases tended to be older than in Lisboa and Vale do Tejo Region. Conclusions: The Directorate-General of Health established the National Observatory of Cysticercosis and Teniiasis which will define criteria for NCC cases monitoring and surveillance (hospitalized and non-hospitalized cases).

Caracterização molecular de cianobactérias de sistemas aquáticos portugueses

As alterações climáticas favorecem a ocorrência global de episódios de precipitação e seca extremas, colocando em risco a qualidade da água em sistemas aquáticos usados consumo humano ou recreação. O fenómeno de seca, em particular, será mais frequente e severo, alterando toda a hidrodinâmica dos sistemas aquáticos e, consequentemente, a ecologia das comunidades aquáticas. A ocorrência de blooms de cianobactérias intensificarse- á sob este novo cenário climático. Em Portugal, estudos parcelares em rios e barragens têm sido realizados com enfoque em cianobactérias tóxicas e outras bactérias patogénicas, mas não há trabalhos publicados acerca da composição da comunidade bacteriana (CCB). O presente trabalho pretende colmatar esta falha, com particular atenção para a ocorrência de blooms cianobacterianos, em vários sistemas aquáticos portugueses lóticos e lênticos. Este objectivo foi alcançado utilizando metodologias moleculares, como a técnica rDNA 16S-DGGE (Denaturing Gradient Gel Electrophoresis), independente do cultivo, e a sequenciação. Dados ambientais foram também determinados para correlacionar com as variações sazonais ou espaciais da diversidade da CCB. O impacto da seca na distribuição espacial da CCB foi também investigado. A lagoa da Vela é um caso de estudo especial, devido à vasta documentação sobre a ocorrência de blooms de cianobactérias durante os últimos anos, e várias estirpes isoladas de blooms foram estudadas em mais detalhe. Os resultados mostraram, em geral, perfis de DGGE típicos de verão vs. inverno nos sistemas aquáticos estudados. Nos sistemas lênticos, os filótipos dominantes afiliaram com Cyanobacteria (formas unicelulares, coloniais e filamentosas), eucariotas fototróficos e Actinobacteria, enquanto nos rios, Bacteroidetes e Betaproteobacteria foram dominantes. Nos sistemas lênticos, os factores mais significativos para a sazonalidade da CCB incluíram a temperatura da água, a condutividade e a clorofila a, apesar da variação extrema dos níveis de precipitação, sugerindo que a BCC poderá resistir a mudanças severas causadas pela seca. Nos rios, a sazonalidade da CCB foi principalmente definida pela temperatura e os níveis de amónia. No verão seco de 2005, as barragens do Alentejo (Sul de Portugal) mostraram similaridade na CCB, com filótipos comuns de Cyanobacteria, Actinobacteria e Alphaproteobacteria. No entanto, os perfis de DGGE sugerem filótipos ubíquos em sistemas portugueses geograficamente distantes. Na Lagoa da Vela, a seca conduziu à redução drástica do nível da água e à variação na diversidade espacial da CCB (e cianobactérias dominantes) e potencial tóxico, o que pode ter impacto directo nos utilizadores da lagoa. Os resultados também mostraram a presença de estirpes tóxicas de Microcystis na lagoa e um bloom não clonal de estirpes de Aphanizomenon aphanizomenoides, com diferentes morfótipos, genótipos e ecótipos.

Examining Ambrosia Pollen Episodes at Poznań (Poland) Using Back-trajectory Analysis

The pollen grains of Ambrosia spp. are considered to be important aeroallergens in parts of southern and central Europe. Back-trajectories have been analysed with the aim of finding the likely sources of Ambrosia pollen grains that arrived at Poznań (Poland). Temporal variations in Ambrosia pollen at Poznań from 1995–2005 were examined in order to identify Ambrosia pollen episodes suitable for further investigation using back-trajectory analysis. The trajectories were calculated using the transport model within the Lagrangian air pollution model, ACDEP (Atmospheric Chemistry and Deposition). Analysis identified two separate populations in Ambrosia pollen episodes, those that peaked in the early morning between 4 a.m. and 8 a.m., and those that peaked in the afternoon between 2 p.m. and 6 p.m.. Six Ambrosia pollen episodes between 2001 and 2005 were examined using backtrajectory analysis. The results showed that Ambrosia pollen episodes that peaked in the early morning usually arrived at Poznań from a southerly direction after passing over southern Poland, the Czech Republic, Slovakia and Hungary, whereas air masses that brought Ambrosia pollen to Poznań during the afternoon arrived from a more easterly direction and predominantly stayed within the borders of Poland. Back-trajectory analysis has shown that there is a possibility that long-range transport brings Ambrosia pollen to Poznań from southern Poland, the Czech Republic, Slovakia and Hungary. There is also a likelihood that Ambrosia is present in Poland, as shown by the arrival of pollen during the afternoon that originated primarily from within the country.

Examining High Magnitude Grass Pollen Episodes at Worcester, United Kingdom, Using Back-Trajectory Analysis

Trajectory analysis is a valuable tool that has been used before in aerobiological studies, to investigate the movement of airborne pollen. This study has employed back-trajectories to examine the four highest grass pollen episodes at Worcester, during the 2001 grass pollen season. The results have shown that the highest grass pollen counts of the 2001 season were reached when air masses arrived from a westerly direction. Back-trajectory analysis has a limited value to forecasters because the method is retrospective and cannot be employed directly for forecasting. However, when used in conjunction with meteorological data this technique can be used to examine high magnitude events in order to identify conditions that lead to high pollen counts.

Investigating Ambrosia Pollen Episodes in Poland Using Back-Trajectory Analysis

Background: The pollen grains of Ambrosia spp. are considered to be important aeroallergens. Previous studies have shown that the long-range transport of Ambrosia pollen to Poland is intermittent and mainly related to the passage of air masses over the Carpathian and Sudetes mountains from sources to the south, e.g. the Czech Republic, Slovakia and Hungary. In this study, Ambrosia pollen counts and back-trajectories from specific episodes in 1999 and 2002 have been analysed with the aim of identifying possible new sources of Ambrosia pollen arriving at three sites in Poland. Method: The combination of Ambrosia pollen measurements (daily average and bi-hourly concentrations) and air mass trajectory calculations were used to investigate two Ambrosia pollen episodes recorded at Rzeszow, Krakow and Poznań on the 4th and 5th September 1999 and 3rd September 2002. Ambrosia pollen counts were recorded by volumetric spore traps of the Hirst design. Trajectories were calculated using the transport model within the Lagrangian air pollution model, ACDEP (Atmospheric Chemistry and Deposition). Results: The collective results of pollen measurements and back-trajectory analysis indicate plumes of Ambrosia pollen travelling up through Poland from the southeast during the investigated episodes. In 1999, the plume was first recorded at Rzeszow in Southeastern Poland during the morning of the 4th September. Its route can be followed as it passed Krakow during the afternoon of the 4th, and later on the 4th and 5th September at Poznań. Similarly, back-trajectories calculated during the morning and afternoon from Krakow and Rzeszow on the 3rd September 2002 indicates that the air masses arrived at these sites from the East or Southeast. Conclusion: This study shows the progress of Ambrosia plumes into Poland from the southeast. Ambrosia pollen release occurs mainly during the day and so a midday peak in Ambrosia pollen concentrations may indicate a local source. However, if the plume of Ambrosia pollen tracked along its northwesterly path over Poland during investigated episodes did not originate from inside Poland, then it is likely that it came from the Ukraine. This identifies a possible new source of ragweed pollen for Poland. Trajectory analysis can only show the path along which an air mass travels, not the specific source area. Further investigation could therefore include source based transport models such as 3D Eulerian atmospheric transport models.

Mass-wasting episodes in the geological evolution of the Azores islands : timing, recurrence, mechanisms and consequence

Tese de doutoramento (co-tutela), Geologia (Geodinâmica Interna), Faculdade de Ciências da Universidade de Lisboa, Faculté des Sciences D’Orsay-Université Paris-Sud, 2014

Patologia borderline : representações relacionais e vulnerabilidades do self

Tese de doutoramento, Psicologia (Psicologia Clínica), Universidade de Lisboa, Faculdade de Psicologia, 2015

Internamentos hospitalares da população com mais de 65 anos em Portugal – Análise Descritiva

RESUMO - As mudanças na saúde são cada vez mais rápidas e os serviços de saúde têm cada vez mais dificuldade em dar resposta aos problemas de saúde dos portugueses. Responsáveis por grande parte da despesa em saúde, os idosos são a população que mais utiliza os serviços de saúde e as respetivas unidades hospitalares e serviços de urgência. Estes têm estadias mais prolongadas e consomem mais recursos durante essas permanências nas instituições de saúde. Sabendo isto revelou-se oportuno encontrar as principais causas de internamento hospitalar, os principais diagnósticos secundários, demoras médias e a sua relação com as principais causas de morte na população portuguesa com mais de 65 anos no período de 2003-2012. Para tal, optou-se por uma análise descritiva de 3375817 episódios de internamento referentes a dez anos. Daqui retirou-se que os diagnósticos principais mais frequentes para todos os anos e todas as faixas etárias são o acidente vascular cerebral isquémico e a pneumonia, sendo que o primeiro é o mais frequente até 2006, passando depois a ser a pneumonia o mais frequente. A demora média é maior quanto mais diagnósticos secundários associados houver e aumenta com a idade. Os diagnósticos secundários mais frequentes são a hipertensão essencial e a diabetes mellitus. Estes dados são relevantes para o conhecimento da saúde em Portugal, podendo-se alterar e uniformizar e melhorar práticas hospitalares e com isso progredir na qualidade dos tratamentos e aumentar a qualidade de vida com hipótese de diminuição da demora média.