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Dysphagia as a Presenting Symptom of Myasthenia Gravis—Case Report

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International Journal of Otolaryngology and Head & Neck Surgery 2014年第1期3卷 23-25页

作者： Sara Ramalho Sandra Pereira Pedro Oliveira Hugo Morais nuno lima Artur Condé Neurology Department Centro Hospitalar Vila Nova de Gaia/Espinho Vila Nova de Gaia Portugal Otolaryngology and Head and Neck Department Centro Hospi-talar Vila Nova de Gaia/Espinho Vila Nova de Gaia Portugal

Dysphagia is a common symptom in otolaryngology, but neuromuscular causes are rarely diagnostic hypotheses to be considered. The Myasthenia Gravis is an autoimmune disease which is characterized by muscle weakness that can affect the muscles of the face, oral cavity, pharynx or esophagus and may present with swallowing disorders. The authors present the case of a 68-year-old man who went to the emergency department of otolaryngology complaining of dysphagia. After the examination and diagnostic exams, it was diagnosed as Myasthenia Gravis. The authors conclude that the clinical suspicion should not be forgotten in order to initiate timely treatment to the effective control of the disease and complement with functional tests according to the complaints, so that it can be followed up and start rehabilitation of the patient.

关键词： Autoimmunity Dysphagia Myasthenia Gravis

Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis:A systematic review and meta-analysis

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Asian Journal of Urology 2024年第2期11卷 261-270页

作者： Andreia Cardoso Aparício Coutinho Gonçalo Neto Sara Anacleto Catarina Laranjo Tinoco nuno Morais Mário Cerqueira-Alves Estevão lima Paulo Mota Department of Urology Hospital de BragaBragaPortugal School of Medicine University of MinhoBragaPortugal Association(2CA-Braga).School of Medicine University of MinhoBragaPortugal

Objective: To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the ***: We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November ***: Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among ***: PCN appears to be the intervention better tolerated, with less impact on the patient’s perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.

关键词： Ureteral stent Percutaneous nephrostomy Obstructive urolithiasis Urinary symptoms Quality of life

Management Accounting Practices in the Portuguese Lodging Industry

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Journal of Modern Accounting and Auditing 2012年第1期8卷 1-14页

作者： Luis lima Santos Conceicao Gomes nuno Arroteia Polytechnic Institute of Leiria Portugal

This paper aims to characterize management accounting techniques at the Portuguese lodging industry, identifying the techniques adopted and the determinants of adopting them and their adequacy for the decision-making process. It is also a purpose to understand the extent to which the industry adopts the Uniform System of Accounts for the Lodging Industry （USALI）. The sample includes 35 hotels, which were analyzed in the years 2009 and 2010. Evidence is found supporting the fact management accounting is a tool incorporated in the daily management practices of hotels and useful to support the decision-making process. The proportion used of traditional management accounting techniques is higher than the proportion of use of contemporary ones. The adoption of these techniques is influenced by the fact of the hotels being subsidiaries of a multinational hotel chain, as well as by their annual turnover. In Portugal, there is a weak use of USALI. It is more used in the large hotels and in hotels with a foreign control. Management accounting supports hotels to improve their performance, thus becoming relevant to analyze management accounting practices used by them, particularly which instruments and techniques. In this context, this study, the first of its kind in Portugal, is justified with the increasing need for accurate and actual information of the accounting practices of the hotels operating in Portugal.

关键词： management accounting lodging industry uniform system of accounts for the lodging industry(USALI) Europe Portugal

Development of a warning score for early detection of colorectal anastomotic leakage:Hype or hope?

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World Journal of Gastrointestinal Surgery 2022年第11期14卷 1297-1309页

作者： nuno J G Rama Óscar Lourenço Patrícia C Motta lima Maria Pedro S Guarino Diana Parente Ricardo Castro Ana Bento Anabela Rocha Fernando Castro-Poças João Pimentel Division of Colorectal Surgical Leiria Hospital CentreLeiria 2410-021Portugal Abel Salazar Biomedical Institute University of OportoOporto 4099-002Portugal Center for Innovative Care and Health Technology(ciTechCare) Polytechnic of LeiriaLeiria 2410-541Portugal Faculty of Economics CeBERUniversity of CoimbraCoimbra 3000-137Portugal Division of Clinical Pathology Leiria Hospital CentreLeiria 2410-541Portugal Division of Surgical Oporto Hospital CentreOporto 4099-001Portugal Department of Gastroenterology Santo António HospitalPorto Hospital CenterOporto 4099-001Portugal Institute of Biomedical Sciences Abel Salazar University of OPortoOporto 4099-001Portugal Faculty of Medicine University of CoimbraCoimbra 3004-531Portugal Division of Surgical Montes Claros HospitalCoimbra 3030-320Portugal

BACKGROUND Colorectal anastomotic leakage(CAL),a severe postoperative complication,is associated with high morbidity,hospital readmission,and overall healthcare *** detection of CAL remains a challenge in clinical ***,some decision models have been developed to increase the diagnostic accuracy of this *** To develop a score based on easily accessible variables to detect CAL *** Based on the least absolute shrinkage and selection operator method,a predictive classification system was developed[Early ColoRectAL Leakage(E-CRALL)score]from a prospective observational,single center cohort,carried out in a colorectal division from a non-academic *** score performance and CAL threshold from postoperative day(POD)3 to POD5 were *** on a precise analytical decision model,the standard clinical practice was compared with the E-CRALL adoption on POD3,POD4,or POD5.A cost-minimization analysis was conducted,on the assumption that all alternatives delivered similar health-related *** In this study,396 patients who underwent colorectal resection surgery with anastomosis,and 6.3%(n=25)developed *** of the patients who developed CAL(n=23;92%)were diagnosed during the first hospital admission,with a median time of diagnosis of 9.0±6.8 *** POD3 to POD5,the area under the receiver operating characteristic curve of the E-CRALL score was 0.82,0.84,and 0.95,*** POD5,if a threshold of 8.29 was chosen,87.4%of anastomotic failures were identified with E-CRALL ***,score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d,if used on POD3 and POD5,*** of score adoption,episode comprehensive costs were markedly greater(up to four times)in patients who developed CAL in comparison with patients who did not develop ***,the use of the E-CRALL warning score was associated with cost savings of€421442.20,with most(92.9%)of the savings from patients

关键词： Anastomotic leakage Colorectal Surgery Biomarkers Score Costs

Usefulness of serum C-reactive protein and calprotectin for the early detection of colorectal anastomotic leakage:A prospective observational study

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World Journal of Gastroenterology 2022年第24期28卷 2758-2774页

作者： nuno J G Rama Marlene C C Lages Maria Pedro S Guarino Óscar Lourenço Patrícia C Motta lima Diana Parente Cândida S G Silva Ricardo Castro Ana Bento Anabela Rocha Fernando Castro-Pocas João Pimente Colorectal Surgical Division Leiria Hospital CentreLeiria 2410-021Portugal Abel Salazar Biomedical Institute(ICBAS) University of OportoOporto 4099-002Portugal Center for Innovative Care and Health Technology(ciTechCare) Polytechnic of LeiriaLeiria 2410-541Portugal Faculty of Economics CeBERUniversity of CoimbraCoimbra 3000-137Portugal Clinical Pathology Division Leiria Hospital CentreLeiria 2410-541Portugal Surgical Division Oporto Hospital CentreOporto 4099-001Portugal Department of Gastroenterology Santo António HospitalPorto Hospital CenterPorto 4099-001Portugal Institute of Biomedical Sciences Abel Salazar University of PortoPorto 4099-001Portugal Faculty of Medicine University of CoimbraCoimbra 3004-531Portugal Surgical Division Montes Claros HospitalCoimbra 3030-320Portugal

BACKGROUND Colorectal anastomotic leakage(CAL)is one of the most dreaded complications after colorectal surgery,with an incidence that can be as high as 27%.This event is associated with increased morbidity and mortality;therefore,its early diagnosis is crucial to reduce clinical consequences and *** biomarkers have been suggested as laboratory tools for the diagnosis of *** To assess the usefulness of plasma C-reactive protein(CRP)and calprotectin(CLP)as early predictors of *** A prospective monocentric observational study was conducted including patients who underwent colorectal resection with anastomosis,from March 2017 to August *** were divided into three groups:G1–no complications;G2–complications not related to CAL;and G3–*** biomarkers were measured and analyzed in the first 5 postoperative days(PODs),namely white blood cell(WBC)count,eosinophil cell count(ECC),CRP,CLP,and procalcitonin(PCT).Clinical criteria,such as abdominal pain and clinical condition,were also *** correlation between biomarkers and CAL was *** operating characteristic(ROC)curve analysis was used to compare the accuracy of these biomarkers as predictors of CAL,and the area under the ROC curve(AUROC),specificity,sensitivity,positive predictive value,and negative predictive value(NPV)during this period were *** In total,25 of 396 patients developed CAL(6.3%),and the mean time for this diagnosis was 9.0±6.8 *** operative characteristics,such as surgical approach,blood loss,intraoperative complications,and duration of the procedure,were notably related to the development of *** length of hospital stay was markedly higher in the group that developed CAL compared with the group with complications other than CAL and the group with no complications(median of 21 d vs 13 d and 7 d respectively;P<0.001).For abdominal pain,the best predictive performance was on POD4 and POD5,with the largest AUROC of 0.84 on ***

关键词： Anastomotic leakage Colorectal Surgery Biomarkers C-reactive protein Calprotectin

Primary Effusion Lymphoma in a HIV-1/2-Infected Patient

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World Journal of AIDS 2023年第3期13卷 116-124页

作者： Maria Caixas lima Pedro Vasques Andreia Paulos André Valente Joana Santos Carla Antunes Matilde Gonçalves Maria Isabel Casella nuno Luis José Poças Department of Infectious Diseases Hospital de S&#227o Bernardo Centro Hospitalar de Setúbal Setúbal Portugal Department of General Surgery Hospital de S&#227o Bernardo Centro Hospitalar de Setúbal Setúbal Portugal Department of Hematology Hospital de Santo António dos Capuchos Centro Hospitalar Lisboa Central Lisboa Portugal Department of Anatomical Pathology Hospital de S&#227o Bernardo Centro Hospitalar de Setúbal Setúbal Portugal

Background: Primary effusion lymphoma (PEL) is a lymphoid proliferation related to Kaposi sarcoma herpesvirus 8/human herpesvirus 8 (KSHV/HHV8) that affects mainly human immunodeficiency virus (HIV) infected individuals but can also occur in other immunodeficiency settings. It is characterized by lymphomatous effusions in different serous body cavities without the presence of a detectable tumor mass. The diagnosis is challenging and the clinical outcomes are poor. Aim: The aim of this paper is to report a rare case of PEL in a man who have sex with women (MSW) with HIV-1/2 infection, history of visceral Kaposi sarcoma (KS) and the development of a seronegative arthritis previous to the lymphoproliferative disease diagnosis. PEL presented with ascites, was treated with high-dose chemotherapy and autologous stem cell transplantation, with a good clinical outcome. Case Presentation: We describe a case of a 48-year-old HIV-1/2-infected patient from a high HHV8 seroprevalent country, hospitalized following a three-month history of increased abdominal volume and general constitutional symptoms. Laboratory data revealed normocytic normochromic anemia and a high level of lactate dehydrogenase. A diagnostic paracentesis was performed with cytology compatible with high-grade B-cell lymphoma. Peritoneal fluid cytology showed large lymphoid cells expressing leucocyte-common antigen CD45 without expression of the CD20 antigen (B-lymphocytes) and positivity for HHV8 by immunocytochemical staining, compatible with the diagnosis of PEL.

关键词： Primary Effusion Lymphoma Acquired Immunodeficiency Syndrome HIV-1 HIV-2 Kaposi Sarcoma Herpesvirus 8/Human Herpesvirus 8 People Living with HIV

Association between IGF-2 gene and fat-free mass in response to resistance training

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Health 2013年第6期5卷 1003-1009页

作者： Andrea Carmem Guimaraes Rinaldo Wellerson Pereira Ricardo Moreno lima Michel Santos Silva Victor Machado dos Reis nuno Domingos Garrido Romulo Maia Ricardo Jacode Oliveira College of Physical Education Catholic University of BrasiliaBrasiliaBrazil College of Physical Education University of BrasiliaBrasiliaBrazil Health Sciences Postgraduate Program University of BrasiliaBrasiliaBrazil Department of Sports Sciences Exercise and HealthUniversity of Tras-os-Montes and Alto DouroVila RealPortugal Research Center for Sports Health&Human DevelopmentCIDESDVila RealPortugal

BACKGROUND: It is well established that the human aging process is associated with a significant decline in neuromuscular function and performance. Twin studies demonstrate that genetic factors partially explain the inter-individual variation of fat-free mass (FFM) and muscle strength. PURPOSE: To examine the association between the polymorphism of the gene IGF-2 with phenotypes strength and muscle mass of elderly women pre and post resistance training. METHODS: 76 elderly women participated in this analysis. These volunteers, who should be sedentary for at least 6 months before the study, were assigned four groups in relation to allele GAGG, AA, GAAA and GG. The first analysis compared 60 elderly women with GG and GA allele (GAGG) versus 16 elderly women with AA allele. The second analysis compared 54 elderly women with GA and AA (GAAA) versus 22 elderly women GG allele. The Body mass index, fat free mass, fat mass and Isokinetic Muscle Peak Torque were measured. All volunteers were participating in the Resistance Training program. The DNA was extracted from peripheral venous blood leukocytes using a salting out protocol. The primer for IGF-II gene exon 9 was 5’-GTCCCTGAACCAGCAAAGAG-3’ 0.5 μM (0.625 μl) Primer R-5’-TGATGGAAAAGGGAGTGAGG-3’ 0.5 μM (0.625 μl), Taq DNA Polimerase enzime 0.5 U (0.1 μl), água milli-Q (3.8 μl) 5 hg de DNA (3 μl). PCR amplification was performed in a programmable thermal cycler GeneAmp? PCR System 9700. RESULTS: The results of the first analysis GAGG × AA versus the group AA showed the relative increase in knee extensor peak torque relative and also in the fat-free mass and showed a decrease in the fat mass percentage in the GAGG group. The second analysis considered the group GAAA versus group GG showed decreases in the fat-free mass percentage in the GAAA group, also showed the relative increase in the fat-free mass in the GG group and decrease in the fat mass percentage in the GG group. CONCLUSIONS: The results of this study show that 2

关键词： Fat-Free Mass Fat Mass Resistance Training Muscle Strength IGF-2 Polymorphism Elderly

Effects of Five Years Adoption of No-Tillage Systems for Vegetables Crops in Soil Organic Matter Contents

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Agricultural Sciences 2018年第1期9卷 117-128页

作者： Carlos E. P. lima ítalo M. R. Guedes Juscimar da Silva Flávia A. Alcantara nuno R. Madeira Agnaldo D. F. Carvalho Mariana R. Fontenelle Embrapa Hortaliç as CNPH Brasília Brazil

Vegetables productions systems are done normally with intense soil tillage causing a strong decline of soil quality. Use of conservation systems can be an alternative to recover this quality. In order to evaluate the effects of such systems on soil organic matter, an experiment has been conducted in randomized blocks design and factorial scheme 3 × 2: three soil management systems (no-tillage;reduced tillage and conventional tillage) and two cover crops (maize single;and intercropping maize with gray velvet bean—Stizolobium niveum);and repeated measures over time. Soil samples were collected before the implementation of the experiment and at the end of each crop cycle until the fifth crop cycle. Carbon associated with humic substances is also determined in 0 - 5 cm, 5 - 10 cm and 10 - 30 cm at the end of the last crop cycle. The SOM content was higher in RT (48.34 g·kg-1) than in the CT (39.48 g·kg-1) at the end of the fifth crop cycle. SOM content in NT (44.92 g·kg-1) was statistically equal to RT and CT, during the same period. In 0 - 5 cm, carbon contents associated to the humic substances present the same behavior of SOM contents in 0 - 10 cm. Probably these results are associated with the capacity of each system to improve superficial contents of SOM stable fractions. It follows that the conservation systems used are alternatives to the cultivation vegetables in order to improve soil organic matter contents.

关键词： No-Tillage Reduced Tillage Soil Conservation Soil Management