Fatores clínicos e sociodemográficos associados a recuperação da marcha de indivíduos após acidente vascular cerebral trombolisado na fase aguda / Clinical and sociodemographic factors associated with gait recovery in individuals after thrombolysis for acute ischemic stroke

O tratamento trombolítico promove reperfusão cerebral após acidente vascular cerebral (AVC) isquêmico, e é considerado o tratamento mais eficaz na fase aguda, estando associado a melhores desfechos clínicos e funcionais. Entre as principais sequelas após AVC estão a hemiparesia e o déficit de equilíbrio, que repercutem diretamente na locomoção do indivíduo. Objetivo: Investigar quais fatores estão associados com a recuperação da marcha na fase aguda do AVC trombolisado. Métodos: Trata-se de um estudo longitudinal, com 32 indivíduos na fase aguda do AVC trombolisado. Os indivíduos foram avaliados nas primeiras horas após terem sido submetidos à terapia trombolítica, e após 7 dias ou no momento da alta da unidade de internamento. Resultados: O desfecho principal foi a presença ou não de marcha independente até o sétimo dia de internamento ou até a alta da unidade. A variável resposta foi o número de dias necessário para recuperar a marcha, sendo analisada em 3 categorias: "1 dia", "2 dias" e "3 ou mais dias". Dos 32 indivíduos da amostra apenas 4 não andaram em até 7 dias após o AVC e cerca de 50% andou no primeiro dia de internamento. Houve associação significativa entre a Escala de Equilíbrio de Berg e o tempo para andar. Conclusão: O estudo sugere que a maioria dos indivíduos submetidos à trombólise para tratamento de AVC isquêmico recupera a capacidade de andar dentro de sete dias da ocorrência do evento, e que esta recuperação está associada ao equilíbrio nas primeiras horas após o AVC.

The thrombolytic treatment promotes cerebral reperfusion after ischemic stroke and it is considered the most effective treatment in the acute phase. The thrombolysis is associated with better clinical and functional outcomes. Hemiparesis and balance deficits are important sequelae after a stroke and both affect the individual's locomotion. Objective: The aim of this study was to investigate what factors are associated with gait recovery in the acute phase of stroke after thrombolysis. Method: This is a longitudinal study, including 32 individuals in the acute phase of stroke after thrombolytic treatment. The individuals were evaluated in the first hours after thrombolytic therapy, and then, after 7 days or at the time of discharge from the inpatient unit. Results: The main outcome was the presence or absence of independent gait until the seventh day of hospitalization or until discharge from the unit. The response variable was the number of days required to recover gait, being analyzed in 3 categories: "1 day", "2 days" and "3 or more days". Of the 32 individuals in the sample, only 4 did not walk within 7 days after the stroke and about 50% walked on the first day of hospitalization. There was a significant association between the Berg Balance Scale and the time to walk. Conclusions: This study suggests that most individuals undergoing thrombolysis for the treatment of ischemic stroke recover their capacity to walk within seven days of the event and this recovery is associated with balance in the first hours after stroke.

Haemoparasites in captive birds at Uberlândia zoo, state of Minas Gerais, Brazil

Haemoparasites are one of the most important groups of bird parasites, with emphasis on the genera Haemoproteus, Plasmodium, Leucocytozoon and Trypanosoma. Zoos sustain different wild animals and are valuable tools for the education and conservation of species. The conditions of captive animals differ from wild animals, as zoos have sufficient availability of food throughout the year, protection against predators and veterinary care for animals. This study aimed to determine the prevalence of haemoparasites in captive birds of the Sabiá Municipal Park Zoo, municipality of Uberlândia, state of Minas Gerais, Brazil. Blood samples were collected from the alveolar vein puncture to make blood swabs. This material was fixed with methanol, stained by the GIEMSA technique and examined under optical microscope. A total of 46 birds (19 species) were analyzed and only three individuals (6.52%) were positive for Plasmodium sp. The hosts were Pavo cristatus and Tyto furcata. This low positivity was expected, since haemoparasites do not generally present high infection rates among birds. Even if a parasite is not pathogenic for a given species, these individuals are important reservoirs for the infection of more vulnerable species. Differences in the prevalence and intensity of infection of these hosts depend on the virulence of the parasite, ability of the host to respond to such infections and vector availability. This low prevalence rate suggests a good health status of the captive birds in the study area.

Assessment of indoor air exposure at residential homes: Inhalation dose and lung deposition of PM10, PM2.5 and ultrafine particles among newborn children and their mothers.

Accurate assessment of particulate matter (PM) dose and respiratory deposition is essential to better understand the risks of exposure to PM and, consequently, to develop the respective risk-control strategies. In homes, this is especially relevant in regards to ultrafine particles (UFP; <0.1 µm) which origin in these environments is mostly due to indoor sources. Thus, this study aimed to estimate inhalation doses for different PM mass/number size fractions (i.e., PM10, PM2.5 and UFP) in indoor air of residential homes and to quantify the deposition (total, regional and lobar) in human respiratory tract for both newborn children and mothers. Indoor real-time measurements of PM10, PM2.5 and UFP were conducted in 65 residential homes situated in Oporto metropolitan area (Portugal). Inhalation doses were estimated based on the physical characteristics of individual subjects and their activity patterns. The multi-path particle dosimetry model was used to quantify age-specific depositions in human respiratory tract. The results showed that 3-month old infants exhibited 4-fold higher inhalation doses than their mothers. PM10 were primarily deposited in the head region (87%), while PM2.5 and UFP depositions mainly occurred in the pulmonary area (39% and 43%, respectively). Subject age affected the pulmonary region and the total lung deposition; higher deposition being observed among the newborns. Similarly, lower lobes (left lobe: 37% and right lobe: 30%) received higher PM deposition than upper and middle lobes; right lobes lung are prone to be more susceptible to respiratory problems, since asymmetric deposition was observed. Considering that PM-related diseases occur at specific sites of respiratory system, quantification of site-specific particle deposition should be predicted in order to better evidence the respective health outcomes resulting from inhaled PM.

Exposure assessment in one central hospital: A multi-approach protocol to achieve an accurate risk characterization.

The bioburden in a Hospital building originates not only from patients, visitors and staff, but is also disseminated by several indoor hospital characteristics and outdoor environmental sources. This study intends to assess the exposure to bioburden in one central Hospital with a multi-approach protocol using active and passive sampling methods. The microbial contamination was also characterized through molecular tools for toxigenic species, antifungal resistance and mycotoxins and endotoxins profile. Two cytotoxicity assays (MTT and resazurin) were conducted with two cell lines (Calu-3 and THP-1), and in vitro pro-inflammatory potential was assessed in THP-1 cell line. Out of the 15 sampling locations 33.3% did not comply with Portuguese legislation regarding bacterial contamination, whereas concerning fungal contamination 60% presented I/O > 1. Toxigenic fungal species were observed in 27% of the sampled rooms (4 out of 15) and qPCR analysis successfully amplified DNA from the Aspergillus sections Flavi and Fumigati, although mycotoxins were not detected. Growth of distinct fungal species was observed on Sabouraud dextrose agar with triazole drugs, such as Aspergillus section Versicolores on 1 mg/L VORI. The highest concentrations of endotoxins were found in settled dust samples and ranged from 5.72 to 23.0 EU.mg-1. While a considerable cytotoxic effect (cell viability < 30%) was observed in one HVAC filter sample with Calu-3 cell line, it was not observed with THP-1 cell line. In air samples a medium cytotoxic effect (61-68% cell viability) was observed in 3 out of 15 samples. The cytokine responses produced a more potent average cell response (46.8 ± 12.3 ρg/mL IL-1ß; 90.8 ± 58.5 ρg/mL TNF-α) on passive samples than air samples (25.5 ± 5.2 ρg/mL IL-1ß and of 19.4 ± 5.2 ρg/mL TNF-α). A multi-approach regarding parameters to assess, sampling and analysis methods should be followed to characterize the biorburden in the Hospital indoor environment. This study supports the importance of considering exposure to complex mixtures in indoor environments.

Reprodutibilidade de testes de resolução temporal em adultos / Reproducibility of temporal resolution tests in adults / Reproducibilidad de pruebas de resolución temporal en adultos

O uso de testes comportamentais é uma prática clínica frequente na audiologia devido à sua grande contribuição ao diagnóstico e aos processos de intervenção fonoaudiológica. Objetivo: Verificar a reprodutibilidade dos protocolos de avaliação da resolução temporal em adultos. Método: Participaram da amostra 34 sujeitos, 22 do sexo feminino e 12 do masculino, com média de idade de 26,21 anos (20 a 52 anos; dp= 8,92) seguindo os critérios: ausência de histórico otológico e/ou audiológico e queixas escolares; normalidade no padrão audiológico e no teste dicótico de dígitos. Foram utilizados na pesquisa os testes Random Gap Detection Test e Gap in Noise, a 50 dB. Ambos foram aplicados em dois momentos, sendo a segunda aplicação com intervalo de uma semana da primeira. O teste Wilcoxon foi utilizado para análise do desempenho da amostra no teste GIN em função da orelha e Teste de Friedman para análise do RGDT em função da frequência testada nos dois momentos. Foi adotado o nível de significância de 5%. O coeficiente de correlação intraclasse foi utilizado na análise da concordância entre as aplicações teste(T1) e reteste (T2) pelo mesmo avaliador (reprodutibilidade). Resultados: Não houve diferença entre as frequências testadas no RGDT (média) no T1 e T2. Houve diferença no desempenho do GIN entre orelha direita e esquerda no T2. A reprodutibilidade de teste-reteste no RGDT (média) e GIN foi substancial conforme o coeficiente de correlação intraclasse. Conclusão: Há reprodutibilidade no teste RGDT quando comparada a média das frequências e no teste GIN bilateralmente.

The behavioral test is frequent clinical practice in audiology due to its contribution to the diagnosis and speech therapy intervention processes. Objective: To verify the reproducibility of temporal resolution assessment protocols in adults. Method: A total of 34 subjects, 22 females and 12 males, with an average age of 26.21 years (20 to 52 years old; dp = 8.92) were included, following the criteria: absence of otological and/or audiological history and school complaints; normality in the audiological pattern and in the dichotic test of digits. The Random Gap Detection and Gap in Noise tests, at 50 dB, were used. Both were applied in two moments; the second application with a one-week interval of the first. The Wilcoxon test was used to analyze the performance of the sample in the GIN test in the ear and Friedman test in order to analyze the RGDT as a function of the frequency tested in the two moments. The level of significance of 5% was adopted. The intraclass correlation coefficient was used in the analysis of the agreement between the test (T1) and retest (T2) applications by the same evaluator (reproducibility). Results: There was no difference between the frequencies tested in the RGDT (mean) in T1 and T2. There was a difference in GIN performance between the ears in T2. The test-retest reproducibility in the RGDT (mean) and GIN was substantial according to the intraclass correlation coefficient. Conclusion: There is reproducibility in the RGDT test when compared to the mean frequencies and in the GIN test bilaterally.

El uso de pruebas comportamentales es una práctica clínica frecuente debido a su contribución al diagnóstico y intervención del lenguaje y del habla. Objetivo: Verificar la reproducibilidad de los protocolos de evaluación de La resolución temporal en adultos. Método: Participaron de la amuestra 34 sujetos, 22 del sexo femenino y 12 del masculino, con un promedio de 26,21 años (20 a 52 años; dp= 8,92) siguiendo los criterios: ausencia de histórico otológico, audiológico y quejas escolares; normalidad del patrón audiológico y en la prueba dicótica de dígitos. Se utilizaron las pruebas Random Gap Detection Test y Gap in Noise, a 50dB. Ambos fueron aplicados en dos momentos, siendo la segunda aplicación con intervalo de una semana de la primera. La prueba Wilcoxon fue utilizada para analizar el rendimiento de la muestra en la prueba GIN en función de la oreja y la prueba de Friedman para el análisis del RGDT en función de la frecuencia probada en los dos momentos. Se adoptó el nivel de significancia del 5%. El coeficiente de correlación intraclase fue utilizado en el análisis de la concordancia entre las aplicaciones test(T1) y reprueba(T2) por el mismo evaluador. Resultados: No hubo diferencia entre las frecuencias probadas en el RGDT en el T1 y T2. Hubo diferencias en rendimiento del GIN entre las orejas en el T2. La reproducibilidad de prueba-reprueba en el RGDT y GIN fue sustancial conforme el coeficiente de correlación intraclase. Conclusión: Hay reproducibilidad en la prueba RGDT cuando se compara el promedio de las frecuencias y la prueba GIN bilateralmente.

Self-disinfecting surfaces and infection control.

According to World Health Organization, every year in the European Union, 4 million patients acquire a healthcare associated infection. Even though some microorganisms represent no threat to healthy people, hospitals harbor different levels of immunocompetent individuals, namely patients receiving immunosuppressors, with previous infections, or those with extremes of age (young children and elderly), requiring the implementation of effective control measures. Public spaces have also been found an important source of infectious disease outbreaks due to poor or none infection control measures applied. In both places, surfaces play a major role on microorganisms' propagation, yet they are very often neglected, with very few guidelines about efficient cleaning measures and microbiological assessment available. To overcome surface contamination problems, new strategies are being designed to limit the microorganisms' ability to survive over surfaces and materials. Surface modification and/or functionalization to prevent contamination is a hot-topic of research and several different approaches have been developed lately. Surfaces with anti-adhesive properties, with incorporated antimicrobial substances or modified with biological active metals are some of the strategies recently proposed. This review intends to summarize the problems associated with contaminated surfaces and their importance on infection spreading, and to present some of the strategies developed to prevent this public health problem, namely some already being commercialized.

Influence of the socieconomic level on the temporal resolution hearing skills in adults / Influência do nível socioeconômico na habilidade auditiva de resolução temporal em adultos

ABSTRACT Objective: to investigate the influence of the socioeconomic level on the temporal resolution auditory ability of adults. Methods: the sample consisted of 48 subjects aged 18 to 50 years, divided into three groups: G1, 11 subjects at level A; G2, 19 in B1 and B2 and G3, 18 in C1, C2, D and E. All subjects presented responses in 20 dB HL in frequencies of 500 to 4000 Hz, during audiometric screening, type A tympanometry, presence of contralateral and ipsilateral acoustic reflexes, no neurological, psychiatric and / or psychological changes diagnosed; without audiological and / or otological complaints and with performance above 95% in the dichotic digit test. The Random Gap Detection and Gap-in-noise tests were performed. The Shapiro-Wilk test for normality analysis and the Kruskall Wallis test for socioeconomic stratum analysis, were used, both with 5% significance. Results: there were statistically significant differences between the groups in the Random Gap Detection in the frequency of 500 Hz and in the average of the frequencies, as a function of the socioeconomic level, the same not being observed in the Gap-in-noise. Conclusions: it is suggested that the socioeconomic level be taken into account in the analysis of the Random Gap Detection test.

RESUMO Objetivo: investigar a influência do nível socioeconômico na habilidade auditiva de resolução temporal de adultos. Métodos: a amostra foi composta por 48 sujeitos na faixa-etária de 18 a 50 anos, (X = 25,40 ± 7,36) divididos por estratos socioeconômicos em três grupos: G1: 11 sujeitos no nível A; G2: 19 no B1 e B2 e G3: 18 no C1, C2, D e E. Todos os sujeitos apresentaram respostas em 20 dB NA nas frequências de 500 a 4000Hz durante a triagem audiométrica, timpanometria tipo A, presença de reflexos acústicos contra e ipsilaterais, não possuíam alterações neurológicas, psiquiátricas e/ou psicológicas diagnosticadas; sem queixas audiológicas e/ou otológicas e com desempenho superior a 95% no teste dicótico de dígitos. Foram realizados os testes Random Gap Detection e o Gap-in-noise. Utilizou-se o teste Shapiro-Wilk para análise de normalidade e o teste de Kruskall Wallis para análise do estrato socioeconômico, ambos com 5% de significância. Resultados: houve diferença estatisticamente significante entre os grupos no Random Gap Detection na frequência de 500 Hz e na média das frequências em função do nível socioeconômico, não sendo observado o mesmo no Gap-in-noise. Conclusões: sugere-se que o nível socioeconômico seja levado em consideração na análise do teste Random Gap Detection.

The Influence of Thermal Comfort on the Quality of Life of Nursing Home Residents.

Thermal comfort (TC) parameters were measured in 130 rooms from nursing homes (NH), following ISO 7730:2005 in order to evaluate the influence of winter season TC indices on quality of life (QoL) in older individuals. Mean radiant temperature (mrT), predicted mean vote (PMV) and predicted percent of dissatisfied people (PPD) indices, and the respective measurement uncertainties were calculated using Monte Carlo Method. The WHOQOL-BREF questionnaire was conducted from September 2012 to April 2013, during the winter season TC sampling campaign. Winter PMV and PPD indices showed significant differences between seasons in median values for comfort. There were also significant differences between seasons for air temperature, air velocity, mrT, and relative humidity. The winter PMV index displayed a "slightly cool" [≤-1] to "cool" [≤-2] in thermal sensation scale [-3 to 3]. PPD index reflected this discomfort as evidenced by a high rate of predicted dissatisfied occupants (64%). The influence of winter season TC on older individual QoL results demonstrated that values of PMV above -0.7 had higher mean score of QoL (coefficient estimate: 11.13 units) compared with values of PMV below -0.7. These findings are of relevance to public health and may be useful for understanding NH indoor environment variables thus implementing preventive policies in terms of standards and guidelines for these susceptible populations.

Indoor fungal diversity in primary schools may differently influence allergic sensitization and asthma in children.

BACKGROUND: Childhood exposure to microbiologic agents may influence the development of allergic and respiratory diseases. Apart from home, children spend most of their time at school, which represents an environment of significant exposure to indoor air microbes. Therefore, we aimed to assess how the prevalence of allergic sensitization and asthma in schoolchildren is affected by microbiologic exposure within classrooms. METHODS: Spirometry with bronchodilation, exhaled nitric oxide measurements and skin-prick tests data were retrieved from 858 children aged 8-10 years attending 71 classrooms in 20 primary schools. Air samples were collected in all classrooms using a single-stage microbiologic air impactor through agar plates. Gram-negative endotoxins were collected using flow control pumps and analysed by limulus amebocyte lysate assay. Diversity scores were established as the number of different fungal species found in each classroom. RESULTS: Classrooms with increased diversity scores showed a significantly lower prevalence of children with atopic sensitization, but not asthma. The risk of sensitization increased with increasing endotoxin exposure in classrooms. Similarly, significantly higher concentrations of Penicillium spp were found in classrooms with a higher number of children with atopic sensitization. CONCLUSIONS: Although no causal relationships could be established, exposure to higher fungal diversity was protective against allergic sensitization but this was not seen for asthma. In contrast, higher exposure to Gram-negative endotoxins and Penicillium spp in primary school's classrooms was associated with increasing odds of allergic sensitization in children.

Children exposure to indoor ultrafine particles in urban and rural school environments.

Extended exposure to ultrafine particles (UFPs) may lead to consequences in children due to their increased susceptibility when compared to older individuals. Since children spend in average 8 h/day in primary schools, assessing the number concentrations of UFPs in these institutions is important in order to evaluate the health risk for children in primary schools caused by indoor air pollution. Thus, the purpose of this study was to assess and determine the sources of indoor UFP number concentrations in urban and rural Portuguese primary schools. Indoor and outdoor ultrafine particle (UFP) number concentrations were measured in six urban schools (US) and two rural schools (RS) located in the north of Portugal, during the heating season. The mean number concentrations of indoor UFPs were significantly higher in urban schools than in rural ones (10.4 × 10(3) and 5.7 × 10(3) pt/cm(3), respectively). Higher UFP levels were associated with higher squared meters per student, floor levels closer to the ground, chalk boards, furniture or floor covering materials made of wood and windows with double-glazing. Indoor number concentrations of ultrafine-particles were inversely correlated with indoor CO2 levels. In the present work, indoor and outdoor concentrations of UFPs in public primary schools located in urban and rural areas were assessed, and the main sources were identified for each environment. The results not only showed that UFP pollution is present in augmented concentrations in US when compared to RS but also revealed some classroom/school characteristics that influence the concentrations of UFPs in primary schools.

The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto.

BACKGROUND: persons who are 65 years or older often spend an important part of their lives indoors thus adverse indoor climate might influence their health status. OBJECTIVE: to evaluate the influence of indoor air quality and contaminants on older people's respiratory health. DESIGN: cross-sectional study. SETTING: 21 long-term care residences (LTC) in the city of Porto, Portugal. SUBJECTS: older people living in LTC with ≥65 years old. METHODS: the Portuguese version of BOLD questionnaire was administered by an interviewer to older residents able to participate (n = 143). Indoor air contaminants (IAC) were measured twice, during winter and summer in 135 areas. Mixed effects logistic regression models were used to study the association between the health questionnaire results and the monitored IAC, adjusted for age, smoking habits, gender and number of years living in the LTC. RESULTS: cough (23%) and sputum (12%) were the major respiratory symptoms, and allergic rhinitis (22%) the main self-reported illness. Overall particulate matter up to 2.5 micrometres in size median concentration was above the reference levels both in winter and summer seasons. Peak values of particulate matter up to 10 micrometres in size (PM10), total volatile organic compounds, carbon dioxide, bacteria and fungi exceeded the reference levels. Older people exposed to PM10 above the reference levels demonstrated higher odds of allergic rhinitis (OR = 2.9, 95% CI: 1.1-7.2). CONCLUSION: high levels of PM10 were associated with 3-fold odds of allergic rhinitis. No association was found between indoor air chemical and biological contaminants and respiratory symptoms.

Indoor air quality and atopic sensitization in primary schools: A follow-up study.

HIGHLIGHTS: The SINPHONIE guidelines were successful in reducing PM2.5 and PM10 in schools.The schools failed to reduce the levels of other IAQ pollutants.No significant changes were observed in the prevalence of atopy. BACKGROUND: The onset and exacerbation of allergic diseases and asthma have been associated with poor indoor air quality (IAQ) inside classrooms. OBJECTIVE: The aim was to investigate how IAQ changed in primary schools after applying indoor air quality recommendations, and to explore how these changes influenced allergic sensitization on children. METHODS: Total volatile organic compounds, PM2.5, PM10, CO2, CO, temperature and relative humidity in the indoor and outdoor air of 20 primary schools were measured in 2010-2012. The school staff received instructions on how to improve IAQ in accordance with the dedicated guidelines. Atopy status was assessed in children attending the participating classrooms by skin prick tests and exhaled nitric oxide. A follow-up sampling campaign was performed in 2014-2015 in the same schools. RESULTS: Indoor PM2.5 and PM10 concentrations were approximately 40% lower in the follow-up measurements (p < 0.05). There were no significant differences regarding outdoor PM concentrations. Nevertheless, PM levels from the follow-up campaign still exceeded the reference value established by Portuguese legislation. Moreover, there were no significant differences in atopic prevalence and FENO values between the campaigns. CONCLUSION: These findings suggest that adoption of the recommendations based on the SINPHONIE guidelines was particularly successful in reducing PM2.5 and PM10 in primary schools of Porto. Nevertheless, the schools failed to reduce the levels of other IAQ pollutants, as well as the prevalence of atopic disease.

Environmental and ventilation assessment in Child Day Care Centers in Porto: the ENVIRH Project.

Children attending day care centers (CDCC) have been reported to be more prone to infectious diseases when compared with those cared for at home, and are exposed to conditions that may increase the risk of allergies and asthma. Several studies revealed that consequences of poor ventilation conditions include high levels of carbon dioxide (CO2) and many other indoor pollutants commonly detected in schools. Nine child day care centers were selected randomly to participate in this study. Fifty-two classrooms were assessed for chemical, biological, physical, and allergen parameters in spring and winter seasons in these nine CDCC located in Porto, Portugal. Outdoor measurements were also conducted for comparison. Our results indicated that (i) particulate matter (PM10) median levels were above the national reference levels, both by classroom type and by season; (ii) TVOC kindergarten peak values may raise some concern; (iii) CO2 was present at high median and maximum levels during spring and winter assessment in both nurseries and kindergartens classrooms; (iv) total bacteria concentrations were 57- and 52-fold higher in the nursery and kindergarten than outdoors, respectively, for the spring season; (v) winter and spring median predicted mean vote (PMV) indices were between "neutral" (0) and "slightly cool" (≤ -1) in the thermal sensation scale for comfort situations (-2 to 2) for both types of classrooms; (vi) there were significant differences for both PMV and predicted percentage of dissatisfied (PPD) indices by season; and (vii) CO2, total bacteria, and gram-negative bacteria were associated with low airflow rates. These data will help to evaluate the effectiveness of current building operation practices in child day care centers regarding indoor air quality and respiratory health.

Biological air contamination in elderly care centers: geria project.

Indoor air quality (IAQ) affects health particularly in susceptible individuals such as the elderly. It has been estimated that the older population spends approximately 19-20 h/d indoors, and the majority of the elderly spend all of their time indoors in elderly care centers (ECC). Older individuals may be particularly at risk of exposure to detrimental effects from pollutants, even at low concentrations, due to common and multiple underlying chronic diseases that increase susceptibility. This study, aimed to assess the impact of indoor biological agents in 22 ECC located in Porto, was conducted during summer and winter from November 2011 to August 2013 at a total of 141 areas within dining rooms, drawing rooms, medical offices, and bedrooms (including the bedridden). Air sampling was carried out with a microbiological air sampler (Merck MAS-100) and using tryptic soy agar for bacteria and malt extract agar for fungi. The results obtained were compared with the recently revised Portuguese standards. In winter, mean fungi concentration exceeded reference values, while bacteria concentrations were within the new standards in both seasons. The main fungi species found indoors were Cladosporium (73%) in summer and Penicillium (67%) in winter. Aspergillus fumigatus, Aspergillus niger, and Aspergillus flavus, known potential pathogenic/toxigenic species, were also identified. Although the overall rate and mean values of bacteria and fungi found in ECC indoor air met Portuguese legislation, some concern is raised by the presence of pathogenic microorganisms. Simple measures, like opening windows and doors to promote air exchange and renewal, may improve effectiveness in enhancing IAQ.

Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience.

BACKGROUND: Surgical treatment of morbid obesity with laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically challenging and involves high-risk patients. In this study, the short-term outcome of LRYGB in a large population of patients has been evaluated, and morbimortality before and after overcoming the learning curve has been assessed. The objective of this study was to establish the learning curve for laparoscopic Roux-en-Y gastric bypass. METHODS: This retrospective study involved 2281 patients submitted to LRYGB at São José do Avaí Hospital between August 1999 and December 2011. The parameters analyzed were operating time, rates of short-term postoperative complications, mortality, and conversion. RESULTS: The study population was predominantly female (71.3%) and presented a mean age of 37.5 years and mean body mass index (BMI) of 45.15 kg/m(2). The average time in surgery was 119 minutes, and average hospital stay was 4.3 days. The incidence of postoperative complications (hemorrhage, fistula, and bowel obstruction) was 1.75%. The relative risk of complications diminished in line with the increased experience of the surgical team and tended to stabilize at<2.5% after the first 500 procedures. The mortality rate was .43%, and the main causes of death were pulmonary embolism and leaks (.14% each). The conversion rate was .17%. CONCLUSION: Operating time and risks of adverse outcome were significantly reduced after a long learning curve of 500 consecutive procedures. The number of surgeries performed and the standardization of the laparoscopic technique used were the main factors contributing to the low rates of postoperative complications, mortality, and conversion.

Indoor air quality and thermal comfort-results of a pilot study in elderly care centers in Portugal.

The age of the European population is rising and percentage of adults aged 65 years and older is projected to increase from 16% in 2000 to 20% in 2020. It has been estimated that older subjects spend approximately 19 to 20 h/d indoors. Older individuals may be particularly at risk for detrimental effects from pollutants, even at low concentrations, due to reduced immunological defenses and multiple underlying chronic diseases. Six Porto, Portugal, urban area elderly care centers (ECC), housing a total of 425 older persons, were studied to assess indoor air quality (IAQ) and thermal comfort (TC) in two seasons. This study presents the IAQ and TC results in 36 rooms and constitutes part of a wider and ongoing study. The study areas were all naturally ventilated, and indoor concentrations in winter were within Portuguese reference values. However, 42% of the participants were dissatisfied with indoor thermal conditions, rating it "slightly cool." In summer, the index rate of dissatisfied individuals was lower (8%). Significant differences were found between seasons in predicted percent of dissatisfied people (PPD) and predicted mean vote (PMV) indices. Fungal concentrations frequently exceeded reference levels (>500 colony-forming units [CFU]/m(3)). In addition, other pollutants occasionally exceeded reference levels. To our knowledge, this is the first study in Portugal to assess effects of indoor air contaminants on the health status and quality of life in older subjects living in ECC. Although IAQ and TC parameters were mostly within reference values, the results suggest a need to improve the balance between IAQ and TC in ECC, a critical environment housing a susceptible population.

Estudo in vivo da etiologia das lesões cervicais não cariosas / In vivo study of the etiology of noncarious cervical lesions

As lesões cervicais não cariosas (LCNCs) são caracterizadas pela perda de estrutura dental no terço cervical dos dentes, que se origina a partir de mecanismos não relacionados com o processo de cárie. Este trabalho buscou investigar a correlação das LCNCs (severidade e acometimento), com os seguintes fatores: idade, sexo, dieta, hábitos parafuncionais, hábitos de higiene dental, distúrbios gástricos e aspectos oclusais. Foram estudados cinquenta pacientes (36 mulheres e 14 homens), com idades entre 20 e 62 anos (média de 40.9 anos). A avaliação consistiu na aplicação de questionários e exame clínico intraoral. Um índice de desgaste dental foi utilizado para classificação da severidade das LCNCs e do desgaste da borda incisal/face oclusal. Os resultados mostraram que os primeiros pré-molares (20,5%), segundos pré-molares (19,5%), caninos (14%), primeiros molares (13,9%) e segundos molares (11,6%) foram os dentes mais acometidos pelas LCNCs. Foi constatada correlação positiva entre idade e o percentual de dentes acometidos, ou seja, quanto maior a idade do paciente, maior foi o percentual de dentes acometidos com LCNC (p=0,003).

Foi constatado que os pacientes com ingestão diária de alimentos e bebidas ácidas apresentaram relação significante com a severidade das LCNCs (p=0,038) e também apresentaram maior percentual de dentes acometidos pelas LCNCs (p=0,014). Não foi verificada relação significante entre as LCNCs (severidade e percentual de dentes acometidos) com o sexo dos pacientes, número de escovações diárias, apertamento dental, bruxismo, distúrbios gástricos, força durante a escovação e tipo de cerdas da escova. Quanto aos aspectos relacionados à oclusão, foi observada pequena correlação (r=0,079) entre o desgaste cervical e o desgaste da borda incisal/face oclusal. Em nenhum caso foi observada diferença estatística significante da severidade das LCNCs entre dentes que participam ou não do movimento de lateralidade.

Noncarious cervical lesions (NCCL) are characterized by loss of tooth structure in the cervical area, and originated by mechanisms unrelated to dental caries process. This study investigated the correlation of NCCL (severity and involvement) with the following factors: age, gender, diet, parafunctional habits, dental hygiene, gastric disorders and occlusal aspects. Fifty patients (36 female and 14 male) aged between 20 and 62 years (mean age of 40.9 years) were evaluated. The evaluation consisted of questionnaires and intraoral clinical examination. A Tooth Wear Index was used to classify the severity of NCCL and wear of the incisal/ occlusal surface. Results indicate that first premolars (20,5%), second premolars (19,5%), canine (14%), first molars (13,9%) and second molars (11,6%) were the teeth most affected by NCCL.

There was correlation between the age of patients and the percentage of teeth affected, meaning that the older the patient, the higher the percentage of teeth affected with NCCL (p=0,003). Patients with daily intake of acidic foods and beverages presented a significant relationship with the severity of NCCL (p=0,038) and also a higher percentage of teeth affected by NCCL (p=0,014). There was no significant relationship between NCCL (severity and percentage of affected teeth) and gender of patients, number of daily brushings, teeth clenching, bruxism, gastric disorders, force applied during toothbrushing and characteristics of the toothbrushes. There was a small correlation (r=0,079) between NCCL and the wear of incisal/occlusal surface. Regarding the severity of NCCL, no significant statistical differences were observed between the teeth involved or not in the lateral excursive movement.