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Lactate clearance in cardiorespiratory emergency  [cached]
Serena Greco,Giovanna Guiotto,Antonino Maffei,Stefania Martino
Emergency Care Journal , 2007, DOI: 10.4081/ecj.2007.4.29
Abstract: Early goal directed therapy has been found to improve prognosis in septic patients, if the therapeutic goal is achieved within the first six hours. The aim of our study is to demonstrate that in patients with acute cardiorespiratory failure, rapid (within 2 hours) lactate clearance can help define patients’ prognosis. 67 consecutive patients, admitted to our 16-bed Emergency Medicine ward for acute cardiorespiratory failure (age 75,9 ± 9,8) (APACHE II score 19,0 ± 4,1), were included in the study. Blood lactate concentration was read at admission and after 2, 6 and 24 hours. We evaluated mortality at seven days and the use of orotracheal intubation (patients with negative outcome) vs. discharge or transfer to a non-emergency ward with subsequent discharge (patients with negative outcome). Lactate concentration at admission was 4,6 ± 2,5 mmol/l; lactate clearance (%) at 2 hours was 40,4 ± 32,1 in patients with a positive outcome and –8,3 ± 5,0 in patients with a negative outcome (p < 0,05). Lactate clearance at 2 hours < 25% is correlated to a negative outcome with an 84,2% sensitivity and a 79,2% specificity. The positive predictive value was 61,5% and the negative predictive value was 92,2%. Systematic lactate clearance monitoring can be used in cases of acute cardiorespiratory insufficiency to identify patients with a high risk of negative outcome. In our study, low clearance at two hours was associated with an increase in mortality and/or the need for orotracheal intubation. Conversely, a clearance at two hours of > 25% in most cases confirms the therapeutic strategy undertaken. Serial evaluation of blood lactate concentration may therefore be useful in guiding treatment strategies.
Anja Scheffers,Dieter Kelletat
Science of Tsunami Hazards , 2005,
Abstract: Lisbon and the mouth of the river Tagus (Tejo) are known to have suffered from the great earthquake and tsunami of November 1st, 1755. Whereas historical sources mention tsunami waves and describe inundation in Lisbon, field evidence from this event has been found only along the Algarve coast and the Spanish Atlantic coast in the south. Our observations in the Cabo da Roca-Cascais area west of Lisbon resulted in the discovery of several very significant tsunami relics in the form of single large boulders, boulder ridges, pebbles and shells high above the modern storm level. Deposition of large amounts of sand by the tsunami waves has intensified eolian rock sculpturing. Abrasion of soil and vegetation still visible in the landscape may point to the great Lisbon event of only some 250 years ago, but radiocarbon and ESR datings also yielded older data. Therefore, we have evidence that the Portuguese coastline has suffered more than one strong tsunami in the Younger Holocene.
Genotypic analysis of Mycobacterium tuberculosis isolates from a Lisbon hospital in Portugal
Perdig?o,Jo?o; Milho,Catarina; Carrilho,Lurdes; Brum,Laura; Portugal,Isabel;
Revista Portuguesa de Pneumologia , 2009,
Abstract: portugal has one of the highest tuberculosis notification rates of the european union with lisbon health region having an incidence rate well above the national average. the present study analyses the transmission, drug susceptibility and characteristics of a study population from a central lisbon?s hospital. one hundred and thirty-two mycobacterium tuberculosis clinical isolates were previously tested for drug susceptibility to first-line drugs. the multidrug (mdr) resistance rate was found to be 3.0%, while 13.6% of the isolates were resistant to one or more first-line drugs. hiv serology was available for 98 patients, 26 (26.5%) were positive. genotyping was performed by miru-vntr and 53 (40,2%) out of the 132 isolates were found to be distributed through 17 miru -vntr clusters of two or more isolates. lisboa strains accounted for 25.8% of all strains. we conclude that transmission of resistant and susceptible mycobacterium tuberculosis strains is occurring, with special concern for lisboa strains.
Effects of apparent temperature on daily mortality in Lisbon and Oporto, Portugal
Sofia P Almeida, Elsa Casimiro, José Calheiros
Environmental Health , 2010, DOI: 10.1186/1476-069x-9-12
Abstract: In this paper time-series analysis was used to model the relationship between mean apparent temperature and daily mortality during the warm season (April to September) in the two largest urban areas in Portugal: Lisbon and Oporto. We used generalized additive Poisson regression models, adjusted for day of week and season.Our results show that in Lisbon, a 1°C increase in mean apparent temperature is associated with a 2.1% (95%CI: 1.6, 2.5), 2.4% (95%CI: 1.7, 3.1) and 1.7% (95%CI: 0.1, 3.4) increase in all-causes, cardiovascular, and respiratory mortality, respectively. In Oporto the increase was 1.5% (95%CI: 1.0, 1.9), 2.1% (95%CI: 1.3, 2.9) and 2.7% (95%CI: 1.2, 4.3) respectively. In both cities, this increase was greater for the group >65 years.Even without extremes in apparent temperature, we observed an association between temperature and daily mortality in Portugal. Additional research is needed to allow for better assessment of vulnerability within populations in Portugal in order to develop more effective heat-related morbidity and mortality public health programs.Climate change impacts on human health are a global concern [1]. Recent extreme weather events, such the European heatwave in 2003, have attracted renewed interest on weather-related health effects [2,3]. Since climate change will likely increase the mean temperature, as well as the frequency of heat events [4] there is an urgent need to evaluate the links between climate and human health, to better identify vulnerable populations and take preventive measures.Previous studies have reported that days of usually low and high ambient temperatures are associated with increases in mortality and morbidity [5-9]. Some groups adopted for a time series approach, while others focus on extreme events such as heat waves and cold spells using episode analysis. In Europe, populations living in urban environments as well as the elderly have a high risk of mortality from ambient heat exposure [10]. If future popula
Ophyra capensis(Wiedemann) (Diptera, Muscidae) found inside the esophagus of a mummy in Lisbon (Portugal)
Couri, Márcia Souto;Cunha, André Mallemont;Souza, Sheila Maria Ferraz Mendon?a de;Laeta, Maíra;
Papéis Avulsos de Zoologia (S?o Paulo) , 2009, DOI: 10.1590/S0031-10492009000600001
Abstract: the present paper aims to describe the material (puparia and adult fragments) of ophyra capensis (wiedemann, 1818) (diptera, muscidae) recently found inside the esophagus of a mummified body from the xix century, in lisbon (portugal). illustrations of the material and a brief discussion are presented. third larvar stadium, pupa and adult of o. capensis and o. ignava are presented.
Effect of air pollution on pediatric respiratory emergency room visits and hospital admissions
Farhat, S.C.L.;Paulo, R.L.P.;Shimoda, T.M.;Concei??o, G.M.S.;Lin, C.A.;Braga, A.L.F.;Warth, M.P.N.;Saldiva, P.H.N.;
Brazilian Journal of Medical and Biological Research , 2005, DOI: 10.1590/S0100-879X2005000200011
Abstract: in order to assess the effect of air pollution on pediatric respiratory morbidity, we carried out a time series study using daily levels of pm10, so2, no2, ozone, and co and daily numbers of pediatric respiratory emergency room visits and hospital admissions at the children's institute of the university of s?o paulo medical school, from august 1996 to august 1997. in this period there were 43,635 hospital emergency room visits, 4534 of which were due to lower respiratory tract disease. the total number of hospital admissions was 6785, 1021 of which were due to lower respiratory tract infectious and/or obstructive diseases. the three health end-points under investigation were the daily number of emergency room visits due to lower respiratory tract diseases, hospital admissions due to pneumonia, and hospital admissions due to asthma or bronchiolitis. generalized additive poisson regression models were fitted, controlling for smooth functions of time, temperature and humidity, and an indicator of weekdays. no2 was positively associated with all outcomes. interquartile range increases (65.04 μg/m3) in no2 moving averages were associated with an 18.4% increase (95% confidence interval, 95% ci = 12.5-24.3) in emergency room visits due to lower respiratory tract diseases (4-day moving average), a 17.6% increase (95% ci = 3.3-32.7) in hospital admissions due to pneumonia or bronchopneumonia (3-day moving average), and a 31.4% increase (95% ci = 7.2-55.7) in hospital admissions due to asthma or bronchiolitis (2-day moving average). the study showed that air pollution considerably affects children's respiratory morbidity, deserving attention from the health authorities.
M. A. Viana-Baptista,P. M.. Soares,J. M. Miranda,J. F. Luis
Science of Tsunami Hazards , 2006,
Abstract: In this study we present preliminary results of flood calculation along Tagus Estuary, a catastrophic event that happened several times in the past, as described in historical documents, and that constitutes one of the major risk sources for Lisbon coastal area. To model inundation we used Mader’s SWAN model for the open ocean propagation with a 2 km grid, and Imamura’s TSUN2 with a 50 m grid covering the entire estuary. The seismic source was computed with the homogeneous elastic half space approach. Modelling results agree with historical reports. Synthetic flood areas correspond to the sites where there are morphological and sedimentary evidences of two known major events that stroke Lisbon: 1531-01-26 and 1755-11-01 tsunamis.
A climatic study of an urban green space: the Gulbenkian Park in Lisbon (Portugal)  [PDF]
Henrique Andrade,Rute Vieira
Finisterra - Revista Portuguesa de Geografia , 2007,
Abstract: Measurements of various climatic parameters were carried out in an average-sized green space in the centre of Lisbon (the Funda o Calouste Gulbenkian Park). The aims consisted of assessing the thermal differentiation between the park and the surrounding built-up area and analysing the microclimatic patterns within the park itself. The main results demonstrate that the park is cooler than the built-up area in all the seasons and both during the daytime and at night, but especially so in the daytime during the summer. The most significant microclimatic contrasts were found to occur with respect to solar radiation and mean radiant temperature, with consequences upon the level of thermal comfort. The structure of the vegetation was also found to have a significant microclimatic influence, since the reduction in the level of incident solar radiation brought on by the presence of groups of trees was much larger than that associated with isolated trees.
Clinical features of adolescents with deliberate self-harm: A case control study in Lisbon, Portugal
Diogo F Guerreiro, Ema L Neves, Rita Navarro, et al
Neuropsychiatric Disease and Treatment , 2009, DOI: http://dx.doi.org/10.2147/NDT.S7488
Abstract: ical features of adolescents with deliberate self-harm: A case control study in Lisbon, Portugal Original Research (5871) Total Article Views Authors: Diogo F Guerreiro, Ema L Neves, Rita Navarro, et al Published Date November 2009 Volume 2009:5 Pages 611 - 617 DOI: http://dx.doi.org/10.2147/NDT.S7488 Diogo F Guerreiro, Ema L Neves, Rita Navarro, Raquel Mendes, Ana Prioste, Diana Ribeiro, Tiago Lila, António Neves, Mónica Salgado, Nazaré Santos, Daniel Sampaio Youth Suicide Study Group (NES), The Hospital Santa Maria, Psychiatry Department, Lisbon Faculty of Medicine, Portugal Abstract: Deliberate self-harm (DSH) among adolescents is a high-risk condition for suicide. The aim of the present study is to describe the characteristic clinical features of adolescents with DSH according to our local context (Lisbon, Portugal), using easily available information from clinical settings. A case control study was constructed from a sample of 100 adolescents (aged 12 to 21 years). The sample was divided into two groups: adolescents with and without DSH. Case files were examined and data was completed by clinical interviews. Demographic, psychosocial, and psychopathological data were assessed and compared. Ninety-eight subjects completed the protocol. The DSH group was associated with the following: suicidal ideation or suicidal behavior as consultation motive, emergency room referral, previous follow-up attempts, suicidal ideation, psychosocial difficulties, or lack of therapeutic goals. There was a nonsignificant trend towards diagnosis of depression in the DSH group. These results reflect our clinical practice with adolescents and add data about teenagers who self-harm to the literature. Prevention and early recognition of DSH (and frequently associated depression) in adolescents are essential and could be life-saving measures. An integrated approach, which takes into account psychosocial difficulties, family dysfunction, and negative expectations, seems to be of great importance.
Diptera Brachycera found inside the esophagus of a mummified adult male from the early XIX century, Lisbon, Portugal
Couri, Márcia Souto;Souza, Sheila Maria Ferraz Mendon?a de;Cunha, André Mallemont;Pinheiro, Jo?o;Cunha, Eugénia;
Memórias do Instituto Oswaldo Cruz , 2008, DOI: 10.1590/S0074-02762008000200015
Abstract: fly puparia and adult fragments of diptera muscid were found inside the esophagus of a mummified body from the early xix century, buried inside the crypt of the sacrament church (lisbon, portugal). the identification of the material revealed a monospecific colonization by ophyra capensis (wiedemann) (diptera: muscidae), a species known to invade corpses in the ammoniacal fermentation wave. this species can be found in corpses kept indoors, not available to the early waves of blowflies (diptera: calliphoridae). in the present case, the number of pupae and their developmental stage suggest that the female invaded the mummified corpse through the partially opened mouth and the oviposition took place directly inside the esophagus. this is the first case of o. capensis infesting internal organs of an intact corpse. the use of chemical products for the embalming process probably explains why external colonization did not occur.
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