Cellular therapy has been used recently in patients suffering from acute myocardial infarction but the results show only a modest improvement in left ventricular structure and function, due to limitations of the cellular product and of the variable dose, often sub-therapeutic. Mesenchymal stem cells from the umbilical cord tissue, when administered into the mice myocardium after induction of myocardial infarction, have decreased the negative impact in the cardiac function, decreasing remodeling, increasing capillary density, limiting cardiomyocyte apoptosis and favoring the proliferation of cardiac progenitor cells.
The 36th Bethesda Conference and the European Society of Cardiology (ESC) developed consensus documents for eligibility or disqualification of athletes with heart disease. These documents, for athletes with implantable cardioverter defibrillator (ICD), only recommend the practice of low intensity sports and with no risk of trauma to the device. The National Collegiate Athletic Association (NCAA) does not follow any of the previously mentioned recommendations and stating that doctors are entirely responsible for the decision. In order to understand what doctors recommend to subjects with ICD regarding the practice of sports, a survey was applied to the members of the Heart Rhythm Society (HRS). This survey yielded conflicting results. In 2012, Rachel Lampert and collaborators presented at the HRS the results of a prospective study, in which they state that athletes with ICD can effectively perform vigorous sports and participate in sports competitions. In May 2013, the aforementioned study was published in the Circulation journal.
The aim of the present paper is to highlight the controversy among the recommendations of the existing consensus documents, what is really recommended in current clinical practice, and the results of a pioneering study by Rachel Lampert and collaborators regarding the practice of sports by athletes with ICD.
Spirometry has been used over the past decades as a way to assess respiratory function in adults and children, applied mostly to individuals older than six. Currently, a significant number of papers are reporting success in training children in preschool age (from two to six years) to perform a spirometry. The aim of the present review is to analyze the most recent and relevant papers, regarding the use of spirometry in preschool children, identifying the criteria to be used to assess the performance of the spirometry and the quality control standards that are better to apply to this age group.
After searching the Pubmed database, a total of 30 papers were analyzed after exclusion of studies that did not address the subject of interest.
The assessment parameters in this age group are different from those used in adults, being suggested the use of FEV0.5 and FEV0.75 instead of FEV1 due to the inability of these children to maintain an expiration time greater than 1 second. It seems that the most important parameter with a higher influence in reference equations is the child height. It is important to use incentive programs that proved to be effective in improving the children’s adherence collaboration to the tests.
The methods for the interpretation of spirometry are different in children and adults, using preferably the Z-scores in the first group. It is expected, in the near future, that the validation of this technique in this age group, as well as its application in daily clinical practice, will happen.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major human pathogen worldwide. However, MRSA prevalence in the Portuguese-speaking African countries (PALOP) and East-Timor is unknown.
Between November 2010 and July 2013, 826 inpatients and 480 healthcare workers from six hospitals located in PALOP countries (São Tomé and Príncipe, Angola and Cape Verde) and two hospitals in East Timor were nasal swabbed for MRSA carriage. Two hundred and fifty height individuals (19.8%) were S. aureus nasal carriers, out of which 86 (33.3%) were resistant to methicillin, corresponding to a global MRSA carriage rate of 6,6%. The highest MRSA prevalence was detected in Angola (13.8%), followed by São Tomé and Príncipe (4.2%) and Cape Verde (1.3%). No MRSA were found in East Timor. Methicillin resistance was higher among S. aureus isolates from Angola (58,1%) and São Tomé (26,9%) comparing to Cape Verde (6%). Moreover, the MRSA prevalence was similar between patients and healthcare workers (7.1% vs 5.6%; p=0.3), out of which the hospital cleaning staff (10.5%) showed the highest MRSA carriage rate, followed by physicians (7.4%) and nurses (6.8%). Regarding the hospital wards, higher MRSA rates were detected in Intensive Care Units (11.7%), pediatrics (6.8%) and orthopedics (6.3%).
The high MRSA rates are worrisome in some of the PALOP countries, pointing out to the need of future surveillance studies and the implementation of more strict and effective infection control measures.
The temporomandibular joint is part of a complex system involving the teeth, jaw, skull, cervical spine and shoulder girdle. Its dysfunction affects largely the adult population between 20 and 40 years old and comprises a complex and multifactorial condition involving a number of different signs and symptoms. There is no consensus on its etiology or diagnostic criteria. Also, there is some disagreement regarding the type of treatment, namely concerning the type of health professionals and techniques involved. This study aimed to understand the contribution of physiotherapy in this type of conditions and the relevance of its integration in the evaluation and treatment process leveraging a maximum functionality and quality of life of the patient.
In contrast to the attention paid to many different critical issues of the exam, the conditions for image visualization in digital mammography do not receive the same level of attention from those who play some role in the process. Therefore, there is, in Portugal, the need to design protocols to warrant the optimal visualization conditions, without which it is not possible to maximize the potential of the whole image acquisition and processing chain.
In the present paper we aim to underline the importance of such protocols, referring some international guidelines which importance made them unavoidable. In addition, we grasp from these guidelines some points that must be addressed when designing the protocols.
The Rabelados leave in a socio religious community, within the island of Santiago, Cape Verde. They are rural workers and until recently they were almost completely isolated to innovation and contact. Until the early 90s, they were not registered, did not attend official schools, did not use public hospitals and instead adopted traditional medicine, and did not accept vaccination of their animals. In the present work we wanted to provide some insights into the health of the individuals of this autoexcluded community aged over 40 years.
Physiotherapy is an autonomous profession, which has a wide field of intervention, ranging from health promotion to disease prevention. Its contribution should be considered as a separate action, integrated at all levels of care.
Palliative care focus on promoting the comfort, dignity and quality of life to people of any age group with diseases incurable, progressive and in advanced stage that exclude the possibility of recovery. Although there is little scientific evidence mentioning the role of the physiotherapist in palliative care, it is possible to conclude that the participation of the physiotherapist in this area contributes positively on quality of life, relieving pain and promoting the welfare of users.
In Portugal, we are still not acting according to the principles, assumptions and key concepts of this area, with a lower percentage of health professionals than it should be, according to the recommendations of the Portuguese Association of Physiotherapists (APF).
It is intended, in this literature review, to analyze the state of the art of the importance of physiotherapy in palliative care.
Family nursing is considered an interdisciplinary field of nursing with a specific body of knowledge that has been developing both in the theoretical domain and clinical practice.
We conducted a qualitative and descriptive study with a sample of 166 undergraduate students of the 4th year of a Nursing course, 53.37 % of whom were attending the Family and Community Nursing class. Our study had two goals: i) to identify the students’ representations of the family nurse developed throughout the course; ii) to identify how students perceive the healthcare approach towards families.
The data analysis followed Bardin’s theoretical reference (2009). The results revealed three categories: the context where nursing healthcare is provided; types of approaches to family healthcare; role of the family nurse.
From the data analysis, we observed that the registration units fitted a model similar to Hanson’s (2005) typology of family nurse practices, even though the students did not mention all the roles defined by the author.
We conclude that throughout the Course the students were able to observe the nurses’ intervention directed to the family, as well as their increasing social visibility and to develop representations about the family nurse.
Background: After the detection of airway obstruction it is common to administrate a bronchodilator and then evaluate the response to the therapeutic. Most societies consider that a positive response to the bronchodilator exists when FEV1 and/or FVC increased 12% and 200mL.
Objeticve: To characterize the response to the bronchodilator according to criteria found in the literature.
Method: Cross-sectional study. The sample included 52 subjects who performed lung function tests, and in whom an airway obstruction was detected with subsequent administration of bronchodilator. The sample was divided according to criteria of bronchodilator response and pulmonary hyperinflation proposed by ATS/ERS (Miller et al., 2005a; Miller et al., 2005b).
Results: For the totality of the sample, the criterion which was able to detect the largest number of subjects with positive response to the bronchodilator was the increase of FEF25-75% ≥10% (63,5%). For the group with the presence of ATS/ERS criteria it was the increase of IC≥10% (76,9%) and for the group without this criteria it was the increase of FEF25-75% ≥10% (61,5%). For the group with pulmonary hyperinflation the best criteria were the increase of FEF25-75% ≥10% (66,7%) and the reduction of RV≥10% (66,7%), and for those without pulmonary hyperinflation it was the increase of FEF25-75% ≥10% (62,2%).
Conclusion: The criterion which was able to detect the largest number of positive responses to bronchodilator was the increase of FEF25-75% ≥10%. However due to the existence of other criteria with good discriminative capacities we suggest a combination of several criteria for the correct characterization of airway reversibility.
Introduction: Although spirometry is the technique that confirms the clinical diagnose of Chronic Obstructive Pulmonary Disease (COPD), it is common practice to perform a more complete evaluation, which may include carbon monoxide diffusion capacity (DLco), arterial blood gases and bronchodilation.
Objective: To characterize DLco and partial pressure of oxygen in arterial blood (PaO2) at rest in patients with COPD, according to the degree of severity of airway obstruction.
Methods: Retrospective, quantitative and cross-sectional study. The sample included 372 individuals of both genders with a diagnosis of COPD who underwent lung function tests between January 2005 and December 2012. The subjects were grouped according to GOLD criteria (2013) for the severity of airway obstruction.
Results: DLco and PaO2 decreased among the four groups GOLD. We found that groups GOLD 1 and GOLD 2 showed a DLco statistically superior (p <0.001) than groups GOLD 3 and GOLD 4 and that group GOLD 3 also had a statistically greater DLco (p=0.001) than the one observed for group GOLD 4. As for PaO2, this parameter was statistically superior (p <0.001) in groups GOLD 1 and GOLD 2 compared to the one found in groups GOLD 3 and GOLD 4.
Conclusion: The parameters DLco and PaO2 changed with the severity of airway obstruction which points to the need, in patients with COPD, to perform a lung functional evaluation that includes assessment of gas exchanges.
The Infection Control in Portugal has its own history, within Europe, with more projection from 1988-1998, with the “Infection Control Project”. The first legal framework for Infection Control Committees (ICC) emerged in 1996, also the guidelines, courses for the ICC professionals, postgraduate training, and surveillance of nosocomial infections (1998-2002). In 2007, the National Infection Control Program was reshaped, and Regional Structures were created to decentralize activities. With the emergence of the Patient Safety area, we perceived a greater involvement of management boards and health professionals, and increased information of the population through the media. In 2013, Infection Control and Antimicrobial Resistance Control were merged into a single Program – a Priority Program. And the future?
The Chronic Obstructive Pulmonary Disease (COPD) is characterized by a persistent bronchial obstruction, partially reversible and progressive, associated with an abnormal inflammatory response of the lungs to inhaled noxious particles or gases.
According to GOLD, spirometry is the primary test conducted in the context of COPD. This pulmonary function test can determine the relationship between forced expiratory volume in the 1st second and forced vital capacity (FEV1/FVC) after bronchodilation, which establishes the presence of airway obstruction. The spirometry can also characterize the degree of severity of bronchial obstruction in these patients by analyzing FEV1 (%). Besides the spirometric parameters other functional respiratory variables like diffusion capacity for carbon monoxide (DLco) and partial pressure of oxygen in arterial blood (PaO2) should be evaluated.
The aim of this review article is to characterize, by analyzing the literature, FEV1, DLco and PaO2 in patients with COPD.
Despite FEV1 (%) is considered the gold standard for characterizing the severity of bronchial obstruction, this parameter has limitations, because its decrease does not always reflect the presence of COPD.
According to the literature, DLco is generally decreased in patients with COPD, reflecting the presence of emphysema, and PaO2 is also diminished. Both values of DLco and PaO2 decrease with the increasing of severity of the obstruction.
Studies have shown that in patients with COPD there is a relationship between FEV1 and DLco with PaO2.
Cardiovascular diseases (CVD) are the leading cause of death in developed countries. About 25% of patients with coronary heart disease have sudden death or risk factor for the occurrence of acute myocardial infarction (AMI), without previous symptoms, and therefore an early diagnosis may improve the prognosis of patients. In recent years, computerized tomography (CT) has been considered an excellent imaging technique evidencing its utility in CVD due to its high diagnostic accuracy in assessing coronary artery disease, being an alternative to invasive coronary angiography. However, the technique has disadvantages, such as radiation dose and artifacts that may lead to diagnostic errors and therefore a new technique applying dual source has been introduced - Dual Source CT. Its configuration may allow an increased diagnostic accuracy through the simultaneous acquisition of two energy spectra in a single image acquisition. According to the literature review, the Dual Source can be advantageous improving the description and communication of findings in the coronary arteries. Detection and characterization of different kinds of coronary plaques in patients with a clinical diagnosis of atherosclerosis, as well as the potential to differentiate between different types of atherosclerotic plaques provides a more detailed analysis of atherosclerotic plaques rupture and erosion considered responsible for AMI. Moreover, a description of the evolutionary injuries caused in the main arteries subjected to atherosclerosis may contribute to a more accurate diagnosis.
The present work intends to make a reflection about conscientious objection in the field of health and more specifically within abortion. In addition to its definition we will also present a brief summary about its historical evolution, limits and application. Moreover, different opinions about the embryo status will be addressed.
Introduction: Musculoskeletal work related injuries (MWRI) are considered one of the greatest health problems among physiotherapists. Although being professionals with expertise in musculoskeletal disorders and respective prevention and intervention strategies, they show a high risk for developing MWRI. Objectives: To estimate the prevalence of MWRI among physiotherapists in Portugal (1 year) and find possible risk factors related to this phenomenon. Methodology: The present study is a descriptive-correlational study by using the Musculoskeletal Nordic Questionnaire applied to Portuguese physiotherapists. Results: 39.6% of the physiotherapists reported MWRI during the past 12 months, with the highest prevalence (8.5%) in the lumbar region. The workload (hours/week), the number of users/day, physical activity beyond the professional activity and a high body mass index (BMI) were found risk factors for an increased number of MWRI, with significant correlations. Conclusion: According to the results obtained in this study, further studies are needed with more homogeneous samples to develop more analytical information for a better understanding of the problems identified and to improve the quality of life of the physiotherapist.